Hypertension and Stress: A Unified Concept

Hypertension and Stress: A Unified Concept

Hypertension and Stress: A Unified Concept

Hypertension and Stress: A Unified Concept


Understanding and treating hypertension has progressed significantly during the past 40 to 50 years. This progress has made a major contribution to health care concerns such as quality of life, prevention of disability, and mortality. In the past, hypertension and hypertensive disease had been a "silent scourge," but it is presently an industry. Research on hypertension has expanded into a variety of fields including epidemiology, endocrinology, surgery, pharmacology, and behavioral medicine. Therapeutic accomplishments have made hypertension a leading source of income for the pharmaceutical industry; the field of clinical pharmacology originated with the development of drugs to treat hypertension. Increasingly, specific drugs to treat specific mechanisms which raise blood pressure have moved from the laboratory to the bedside.

A constant awareness has been present that emotional stress, both from within the individual as well as from environmental sources, plays a role in the "three Ps" -- predisposition, precipitation, and perpetuation -- of hypertension. Arguments range from stating that such stress may be the major cause of at least some forms of hypertension, to allowing that although some effect is present from stress, it is only a minor perturbation of no significance in the overall pattern of the disease. Advocates of stress theory may be biased by a lack of detailed knowledge or experience with the physiology and biochemistry involved in the establishment of this disorder. On the other hand, those who deny the importance of stress factors may be unaware of the large body of data that indicate the role of these factors in any comprehensive understanding of hypertension.

Following the Mosaic Theory, this book's approach to hypertension shows that multiple factors can be invoked in understanding the etiology and management of hypertension, where the strength of individual factors vary depending on genetic background, acquired diseases, and environmental influences. Stress can be involved in predisposition by affecting a genetically programmed person, in precipitation by supplying the stimulus to bring the disease to a clinical level, and in perpetuation by maintaining or exacerbating the clinical disease. This volume attempts to integrate what is known about the effects of stress on blood pressure with the overall mosaic of hypertension making use of the aforementioned "three Ps" as part of the framework for this integration.


I have written this book to explain the apparent dichotomy displayed by my seemingly discordant and diverse interests in hypertensive disease over the past 50 years. I have made physiological and pharmacological contributions to the understanding of hypertension and have been an active clinician in treating many patients with hypertension both as their primary internist as well as a consultant. As such, I have been a participant with colleagues of similar interests in the development of knowledge of this disorder over the years. Yet, during all of this time, I have had a major concern about the role of psychological and behavioral events on the course of hypertension, which rose out of the fact that my background had included training in psychiatry and psychosomatic disease. This latter interest has caused my fellow internists and clinical investigators to refer to me as a behaviorist/psychiatrist, whereas my colleagues in psychosomatic and behavioral science consider me to be one who contributes knowledge of cardiovascular physiology and clinical pharmacology in their midst.

I have tried to explain to both groups that there is no dichotomy in my thinking about the different aspects of this disease, and at times I have been successful in persuading some of my students of this fact. Stress factors in hypertension are as real as biochemical sequences and indeed are transmitted by the same metabolic . . .

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