The probability-tradeoff technique may be used to assess treatment preferences in dichotomous choices. In this feasibility study, it was used to elicit benign prostatic hyperplasia (BPH) patients' attitudes towards three different treatments. Eighty-seven male outpatients used rating scales and the standard gamble to indicate the extents to which they were free of BPH symptoms. Paired descriptions of "watchful waiting" (WW), treatment with an alpha blocker (AB), and transurethral resection of the prostate (TURP) were presented, and the probability-tradeoff technique was used to obtain treatment-preference scores. The tradeoff task identified six internally consistent preference-order subgroups. The majority (n = 55; 63.2%) were in the two subgroups in which TURP was the least-preferred treatment. Compared with the other respondents, the members of these two subgroups reported significantly higher utilities for their BPH symptom status (89 vs 79; t = 2.87; p < 0.0005). Within each subgroup, preference scores for the middle- and top-ranked treatments were computed relative to the bottom-ranked treatment; for both WW and AB, significant across-subgroup differences were observed. In this preliminary study the probability-tradeoff technique was feasible, able to identify unique preference-order subgroups, and able to generate apparently meaningful preference scores in a clinical situation involving three alternative treatments. Further development of tradeoff tasks as the value-clarification component of decision aids for individual patients seems warranted.

In this study, we examined autonomic influences on pulse transit time measured from the R-wave of the electrocardiogram (R-PTT). Six subjects received three doses each of isoproterenol and atropine. Isoproterenol produced a significant linear decrease in R-PTT, a significant linear increase in heart rate (HR), and a significant linear decrease in diastolic blood pressure (DBP). Atropine produced a significant linear decrease in R-PTT and significant linear increases in HR and DBP. The R-PTT shortening effect of isoproterenol may reflect positive inotropic effects of beta-sympathetic myocardial stimulation. The R-PTT shortening effect of atropine may reflect reduction of parasympathetic inhibition of ventricular myocardial activity. However, possible vascular contributions to these effects remain to be determined. Nonetheless, the results encourage further examination of R-PTT in research concerning autonomic regulation of cardiovascular activity.

Comparison of mild-to-moderate essential hypertension patients treated for 6 weeks by antihypertensive medication versus metronome-conditioned relaxation versus biofeedback versus a mild exercise control procedure showed that those on medication achieved the greatest decrease in blood pressure. The relaxation and biofeedback groups decreased more than the mild exercise group, as predicted, but not significantly more. The differences in benefits of the groups were not a function of group differences in initial blood pressure levels nor in compliance. Nor did the groups differ in the side effects that are usually associated with medications. A second phase of 6 weeks with another treatment or combination of treatments did not add significantly. Some characteristics of patients moderately predicted treatment benefits, for example, high scores on the Jenkins Activity Survey Scales (1) [Type A, S or H], for the relaxation and biofeedback treated patients predicted which patients received greater benefits.

This study addresses the hypothesis that electrocardiographic T-wave amplitude is influenced by beta-adrenergic stimulation of the heart. Beta-adrenergic activity was manipulated both pharmacologically and through behavioral challenge. Under resting conditions, 12 healthy men underwent infusion of placebo and then the beta-agonist, isoproterenol, and the beta-blocker, propranolol, in a counterbalanced, crossover design. During infusion of placebo, subjects also underwent two behavioral challenges, a structured interview and mental arithmetic. Analysis of the resting data indicated that propranolol produced a significant increase in T-wave amplitude, and isoproterenol produced significant T-wave amplitude attenuation. As previously reported, drug effects were also in evidence for heart rate. Behaviorally-induced reduction of T-wave amplitude was observed for mental arithmetic but not structured interview, which again paralleled heart rate data. Both pharmacological and behavioral data reported in this study support the hypothesis that the T-wave is significantly affected by beta-sympathetic influence on the heart. However, a nonspecific effect of heart rate change on T-wave amplitude would also account for these results. The findings are discussed in terms of their implications for the utility of T-wave amplitude in psychophysiological research.

This report examines the hypothesis that electrocardiographic T-wave amplitude is sensitive to graded increases in beta-sympathetic stimulation of the heart. Beta-adrenergic activity was manipulated pharmacologically in 9 healthy men by bolus infusion of isoproterenol in each of six doses: 0.1, 0.25, 0.5, 1.0, 2.0, and 4.0 micrograms. Results indicated that elevations in heart rate above placebo values increased as a linear function of isoproterenol dose. In contrast, the dose-response curve for T-wave amplitude was best described by a quadratic function: an initial reduction in T-wave amplitude at low levels of isoproterenol infusion was followed by a significant reversal of this effect at higher doses. Comparison of the heart rate and T-wave amplitude data points to limitations in the use of the latter as an index of beta-adrenergic activity. One of several possible explanations for the T-wave results would entail a mechanism that preserves ventricular function at high levels of beta-sympathetic stimulation.