Psychosomatic factors in borderline hypertensive subjects and offspring of hypertensive parents.

Abstract

Psychosomatic factors, sympathoneural and sympathoadrenal as well as cardiovascular mechanisms, were studied in 24 patients 18-24 years of age with borderline hypertension, 50 age-matched nonnotensive offspring of hypertensive parents, and 49 controls with no family history of hypertension. They were compared by projective and questionnaire-based psychological tests and their circulatory and neurohormonal reactivity to mental (Stroop color-word conflict test and arithmetic test) and physical stressors (orthostasis and bicycle ergometry test) were measured. Borderline hypertensive subjects externalized aggression less (p<0.05) but internalized it more (/?<0.05) and were more submissive (p<0.05) when compared with controls. Offspring of hypertensive parents showed a similar but weaker pattern. Both risk groups reported more positive interactions with their parents (genetic risk subjects versus controls, p<0.05; borderline hypertensive patients versus controls, p=0.08) and had higher state-anxiety levels (p<0.05). There were more subjective symptoms of £-adrenergic receptormediated functions (e.g., tachycardia, tremor) in borderline hypertensive subjects and offspring of hypertensive parents, elevated heart rates (analysis of repeated measures, p< 0.001), and enhanced plasma norepinephrine concentrations (p<0.05) when compared with controls. These findings in subjects at risk for the development of hypertension suggest that psychosomatic factors and sympathetic overactivity are involved in the early phase of hypertension. Neurogenically mediated excessive responsiveness to stressful stimuli has been proposed as a pathophysiological mechanism. More frequent, larger, and longer-lasting pressor responses result in a pressurerelated impairment of baroreceptor reflexes followed by a resetting, 4 or lead to structural adaptive changes in the resistance vessels. 5 In addition, enhanced sympathetic nervous system activity may result in increases in cardiac output, vascular resistance, and sodium and water retention and thereby elevated levels of blood pressure. 6 In accepting a psychosomatic approach to the pathogenesis of hypertension, the psychosomatic factor must be present well before the development of high blood pressure. We therefore investigated risk groups (i.e., patients with borderline hypertension 7 and nonnotensive subjects with a family history of hypertension 8 ) rather than established hypertensive patients. Psychological characteristics were assessed by projective and questionnaire-based psychological tests in an endeavour to differentiate the above risk groups from a control population with a low risk of hypertension. Responses to stressors (i.e., cognitive tasks and physical exercise) were compared by measuring cardiovascular and biochemical stress markers. Methods SubjectsOf the 123 subjects, 18-24 years old and of both sexes, all were Caucasian: Twenty-four were consecutive untreated outpatients with borderline hypertension (15 with and nine without a family history of by guest on May 9, 2018 http://hy...

Personality Type and Neural Circulatory Control

“…17,18 Behavioral responses are frequently accompanied by sympathetic activation. These behavioral responses are regulated by central control mechanisms, which are linked closely to brain stem centers that modulate autonomic outflow.…”

A Double-Blind Study of Psychosocial Factors in 40-Year-Old Women with Essential Hypertension

“…Other studies have also shown different associations between elevated psy chiatric symptoms, hostility and hypertension for male and female patients [29]. Borderline hypertensive subjects have been found to in ternalize aggression more than normotensives [30]. This is important, as suppressed aggres sion emerged as a superimposed permissive factor for a steeper trajectory or acceleration of early development of hypertension [31].…”

The Autonomic Nervous System and Hypertension

“…Moreover, these abnormalities are detectable when measured during maneuvers that activate autonomic cardiovascular control. [9][10][11][12][13] Pressor responses to a variety of laboratory stressors have also been examined and found to predict the subsequent development of hypertension. 14,15 Furthermore, in a more refined experimental approach (measurement of the clearance of norepinephrine after the infusion of small amounts of its radiolabeled form), it was shown that the increase in norepinephrine is not due to its reduced tissue disposal but rather to an enhanced spillover rate from neuroeffective junctions and thus to augmented norepinephrine secretion from sympathetic nerve terminals.…”