PSYCHOPHYSIOLOGIC MECHANISMS IN HYPERTENSIVE VASCULAR DISEASE

Abstract

The status of our knowledge concerning the psychophysiologic aspects of hypertensive cardiovascular disease has been reviewed. There is ample evidence that physiologic pathways exist by which emotions can be translated into blood pressure elevation and that these pathways operate by means of both neurogenic and humoral mechanisms. Such effects are undoubtedly responsible for many of the acute and even chronic elevations of blood pressure seen in hypertensive individuals and are probably some of the factors causing aggravation of the disease. However, evidence suggests that many variables, including age, sex, and intensity and meaning of the psychological event, influence both the qualitative and quantitative nature of the pressor response to noxious stimuli. Considerable research, utilizing both psychological and physiological techniques, is necessary to clarify the relative contributions of these variables. It seems unlikely that psychogenic disturbances are ever solely responsible for the original development of hypertensive vascular disease, but the evidence does suggest that these influences are involved as contributing causes, as for instance by interacting with a genetic or acquired vascular predisposition. The so-called "hypertensive personality" probably does not exist as a unique clinical entity, but studies of hypertensive patients do demonstrate a consistent pattern of behavior in their interpersonal relationships. This pattern is characterized by fear of rejection by key figures and results particularly in the inability of the patient to handle aggressive impulses. Although only in rare instances is intensive psychotherapy feasible for hypertension per se, nevertheless awareness by the physician of these key conflicts allows the use of supportive psychotherapy which will contribute significantly to improved overall medical management. It seems well established that both amelioration of symptoms and of blood pressure, and perhaps slowing of progression, result at least in part from such supportive therapy. It is emphasized in conclusion that psychophysiologic mechanisms play an important role in all aspects of hypertensive disease, and that investigators, whether they deal primarily with therapy, hemodynamics, or etiology, must consider this parameter.