Hostility, Social Support, and Ambulatory Cardiovascular Activity

The present study compared ambulatory blood pressure in male and female subjects preselected for high and low hostility levels and investigated interpersonal daily stress as a possible mediational mechanism. Ambulatory blood pressure and heart rate were measured in 48 male and female students previously classified as high or low on the Cook-Medley Hostility (Ho) Scale. Subjects wore an ambulatory monitor for a working day and also completed measures of perceived social support, daily interpersonal stress, and health behavior information. Results indicated that subjects scoring high on the Ho scale had higher mean levels of ambulatory systolic blood pressure than low Ho subjects, even when controlling for traditional risk factors, such as cigarette smoking. High Ho subjects also reported greater daily interpersonal stress and less social support than low Ho subjects. Perceived interpersonal stress partially accounted for the relationship between hostility and blood pressure. Subjects high in hostility showed greater mean ambulatory systolic blood pressure levels. Consistent with the transactional model of hostility and health, the relationship between hostility and blood pressure appears to be partially accounted for by the daily experience of interpersonal stress.     

The Effects of Task Demand and Decision Latitude on Cardiovascular Reactivity to Stress

Abstract

This study investigated the effects of task demand (absence or presence of time pressure) and decision latitude (choice or no choice over a task) on cardiovascular and affective responses to stressful tasks among 70 college students. Subjects also rated whether they felt under pressure and the extent to which they felt in control. Time pressure was related to elevated systolic blood pressure (SBP) responses among men and increased negative affect for both sexes. Lack of choice over the task also resulted in increased negative affect in both sexes. The least stressful condition—having a choice in the absence of time pressure—resulted in reduced negative affect. In addition to the effects of manipulated decision latitude and demand, perceptions of being in control were associated with reduced SBP among women who had a choice. Perceived control also contributed to reduced negative affect among men. These results suggest that the postulated negative effects of high demand and low decision latitude (ie, job strain) on cardiovascular health may be mediated in part by increased cardiovascular reactivity and negative affect.     

Reaction

The present study tested the hypothesis that Type A subjects respond with greater cardiovascular response than Type B subjects during the structured interview used to assess the Type A pattern. Coronary patients (n = 31) and patient controls (n = 33) were subjected to the interview and a history quiz while ECG and blood pressure were monitored. As predicted. Type A relative to Type B subjects evidenced significantly greater increases in both systolic and diastolic blood pressure, which were sustained over the course of the entire 12-15 minute interview. Type A subjects compared with B's also showed significantly greater blood pressure elevations during the quiz. Coronary patients displayed significantly greater Type A attributes than control subjects and tended to show greater blood pressure elevations than controls during the interview. In addition, the quiz induced significant elevations in the blood pressure of coronary patients, but not patient controls, over that displayed during the interview, despite the presence of beta-adrenergic blocking medication. Implications of the findings for coronary-prone behavior and coronary heart disease are discussed.     

Health Patterns Associated with Type a Behavior: A Managerial Population

Abstract

Type A Behavior is a behavioral syndrome found to be related to coronary heart disease and characterized by excessive drive, ambition, and competitiveness. Managers from 12 different companies were examined for this syndrome and for a number of the known risk factors in coronary heart disease (blood pressure. cholesterol, triglycerides, uric acid, smoking. and fitness).

Those individuals exhibiting extreme Type A Behavior (Type A₁) showed significantly higher blood pressure (systolic and diastolic) and higher cholesterol and triglyceride levels. A greater percentage of these individuals were cigarette smokers. On serum uric acid there were no differences. In each age group. Type A's were less interested in exercise, although differences in cardio-respiratory fitness were found only in the oldest age group.

Type A Behavior also was related to age, education, company growth rates, and stress symptoms.

Overall, the Type A₁'s were found to be higher on a number of risk factors known to be associated with coronary heart disease. With regard to the Type A₂'s (individuals with less developed Type A Behavior), the findings were not conclusive.     

Influences of Potential for Hostility, Type A Behavior, and Parental History of Hypertension on Adolescents'' Cardiovascular Responses During Stress

We investigated the influences of Type A behavior, potential for hostility, and parental history of diagnosed hypertension on adolescents’ cardiovascular responses to three behavioral stressors. The participants were 72 male and 99 female adolescents enrolled in grades 6 to 12. Results showed that adolescents with a hypertensive parent had larger diastolic blood pressure responses during all three stressors than did adolescents without hypertensive parents; this effect was particularly pronounced among the Type As. Adolescents rated as high on potential for hostility had elevated systolic and diastolic blood pressure responses, particularly during isometric exercise. Results regarding parental history of hypertension and Type A replicate previous studies in adolescents. Results regarding potential for hostility showed for the first time that early signs of hostility are related to psychophysiological responses thought to be pathophysiological mechanisms in the etiology of cardiovascular diseases.     

Harassment,hostility, and Type A as determinants of cardiovascular reactivity during competition

Anger/hostility and Type A behavior have been implicated in elevated cardiovascular reactivity and disease. In the present experiment systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were monitored during conditions of competition alone or in conjunction with goal blocking or harassment. Cardiovascular reactivity was examined as a function of conditions, Type A or B pattern, and various measures of anger/hostility. Harassment elicited significantly elevated SBP and HR changes relative to goal-blocking and control conditions. Type As reliably exceeded Type Bs in magnitude of SBP change during the harassment condition only. However, exploratory analyses correlating anger/hostility measures and cardiovascular reactivity indicated that only subjects scoring high on the Buss-Durkee Hostility Inventory showed significantly elevated SBP reactivity as a function of Type A behavior pattern, rated hostility during the A-B interview, or outward expression of anger assessed by the Framingham Anger-In vs Anger-Out Scale.This study was supported in part by National Heart, Lung and Blood Institute (NHLBI) Training Grant HL07426 to the University of Miami. We thank Professor T. Dembroski for his overall consultation during the study and for providing training in the administration and scoring of the Type A structured interview and components.     

The relationship between trait hostility and cardiovascular reactivity: A quantitative review and analysis

Results of a series of meta-analyses indicated that high and low scorers on most trait hostility measures do not consistently differ in blood pressure or heart rate reactivity to traditional laboratory stressors. The few significant effects were modest in size, and instances of hyporeactivity were found. When stressors were classified as provocative versus nonprovocative, in accord with Trait x Situation approaches, however, Potential for Hostility-Interpersonal Style was predictive of exaggerated systolic and diastolic blood pressure responses and the Cook–Medley Hostility Inventory was predictive of diastolic blood pressure responses to provocative stressors. Hence, the next generation of studies of the hostility–reactivity hypothesis should emphasize interpersonal stressors. Alternative mechanisms for the disease consequences of hostility should also be examined, however, because the available evidence indicates that the hyperreactivity hypothesis is unlikely to furnish a complete explanation for the association between hostility and heart disease.     

Cardiovascular Responses to Emotional Stress (Quiz Interview) in Post-Myocardial Infarction Patients and Matched Control Subjects

Abstract

In this investigation, 30 male post-myocardial infarction patients and 30 male control subjects matched according to age and occupation were given a 12-minute tape-recorded stress quiz described by Schiffer et al.' Cardiovascular responses (electrocardiogram, heart rate, systolic, blood pressure, and diastolic blood pressure) to emotional stimuli were monitored in a laboratory setting at rest before the quiz and at two-minute intervals during the quiz. Heart rate and blood pressure values were significantly higher during the quiz than at rest for both patient and control groups. There was a significantly higher response for diastolic pressure and a significantly lower response for heart rate in the patient group compared with the control group. In the analysis for occupational status in the entire population, systolic pressure was significantly higher for the executives than for non-executives. Subgroup analyses of patients with angina, hypertension and/or ECG changes (N=12) revealed a significantly higher diastolic pressure response than found in either the patients without these symptoms (N=18) or in the controls (N=30). In comparison to exercise test results, the emotional stress test (quiz) elicited somewhat more PVC's but less ST segment depression. These results support previous reports suggesting that emotional stress testing may be a valid tool in the diagnosis of coronary heart disease and in determining the physiological mechanisms which underlie the association between emotional stress and coronary heart disease.     

Relationships between hostility and physiological coronary heart disease risk factors in young adults: the moderating influence of depressive tendencies

BACKGROUND: We examined whether the relationships between hostility and physiological coronary heart disease (CHD) risk factors differ as a function of depressive tendencies (DT). METHODS: The participants were 672 randomly selected healthy young adults who self-reported their hostility (anger, cynicism, and paranoia) and DT. The physiological CHD risk factors studied were systolic blood pressure, diastolic blood pressure, body-mass index, serum high-density lipoprotein cholesterol, serum low-density lipoprotein cholesterol and serum triglycerides. RESULTS: We found that hostility was negatively associated with the physiological CHD risk factors among individuals exhibiting high DT while hostility was positively associated with, or unrelated to, the physiological risk factors among individuals showing low DT. The Hostility x DT interaction explained 2 to 5 % of the variance in the physiological parameters. CONCLUSION: The findings suggest that DT have a moderating influence on the relationships between hostility and CHD risk. Despite the established risk factor status of hostility, lack of anger and hostility, when combined with high DT, may represent the most severe exhaustion where the individual has given up. Disregard of this fact may explain some null findings in the research on hostility and CHD risk.     

Additional Evidence for the Relationship Between Type a Behavior and Social Support in Men

Abstract

This study examined social support as a mediator of susceptibility to coronary disease in Type A individuals. Sixty-four male subjects completed the Jenkins Activity Survey and the Sarason Social Support Questionnaire. The correlations between Type A scores, the speed and impatience and hard-driving competitiveness factors of the Jenkins survey, and Sarason's social support were found to be negative, which was contrary to earlier findings.¹ The authors hypothesize that these differing results may be a function of age and environment. Finally, and pertinent to the mechanism by which social support may be associated with coronary heart disease, systolic blood pressure was negatively correlated to satisfaction with social support.     

Dimensions of hostility in men, women, and boys: relationships to personality and cardiovascular responses to stress.

Ratings of Potential for Hostility and Hostile Style based on responses during the Type A Structured Interview (SI) are related to incidence of coronary heart disease morbidity and mortality. As there are very limited data on what precisely the SI ratings of hostility mean, the present study evaluated, in a sample of middle-aged men and women, and adolescent boys, a) the distributions of SI ratings of hostility according to gender and age group; b) their relationships to other hostility and personality scores; and c) their relationships to heightened cardiovascular responses to psychological stressors, which are thought to be a major mechanism linking behavior and coronary heart disease. Results showed that men are higher than women and boys in Potential for Hostility and Hostile Style ratings, which are, by and large, unrelated to standardized questionnaire measures of hostility and anger expression. Men (but not women or boys) who exhibited elevated systolic blood pressure during standardized laboratory stressors tended to be rated as high on Hostile Style. We conclude that SI Hostile Style ratings are measuring a unique aspect of personality, one with apparent importance for coronary heart disease and perhaps for men's cardiovascular responses during stress.     

Increasing constructive anger verbal behavior decreases resting blood pressure: A secondary analysis of a randomized controlled hostility intervention

We hypothesized that increasing anger verbal behavior in an assertive, constructively motivated style should decrease resting blood pressure (BP) and that this behavior may be one mechanism through which hostility relates to BP. We tested this hypothesis by conducting secondary analyses on a single-blind, matched, randomized controlled study of hostility modification and BP. A total of 22 high-hostile male patients with coronary heart disease were matched on age and hostility level and were randomly assigned to either an 8-week cognitive-behavioral hostility treatment (n = 10) or an information-control group (n = 12). Patients were reassessed after treatment and at 2-month follow-up on hostility, observed anger expression, and resting BP. We found that decreases in hostility predicted increases in constructive anger behavior-verbal component, which in turn predicted decreases in resting BP at follow-up. Thus, one of the mechanisms underlying the hostility-BP association may be the lack of constructive anger expression.     

Disturbed calcium metabolism in subjects with elevated diastolic blood pressure

Summary Essential hypertension has been associated with disturbed calcium metabolism, but the available data are controversial. We measured parameters of calcium metabolism in groups of untreated male subjects (n = 78) with elevated diastolic blood pressure (101 ± 6 mmHg, mean ± SD) and age-matched male subjects (n=79) with low diastolic blood pressure (62 ± 4 mmHg). The participants of the study were drawn from a random population sample. Subjects with high diastolic blood pressure had significantly higher carboxy-terminal parathyroid hormone (PTH) plasma concentrations than controls with low diastolic blood pressure (median 114 vs. 43 pmol/l, P < 0.01). The 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations were comparable in both groups. Individuals with high diastolic blood pressure had significantly lower total serum calcium (2.41 ± 0.10 vs. 2.47 ± 0.10 mmol/l, mean ± SD; P < 0.01). PTH concentrations were correlated with diastolic pressure (r = –0.39, P < 0.001). The data are compatible with increased parathyroid activity despite unchanged concentrations of vitamin D metabolites in human hypertension.Abbreviations PTH parathyroid hormone - C-PTH carboxy-terminal parathyroid hormone - 1,25(OH)₂D 1,25-di-hydroxyvitamin D - 25(OH)D 25-hydroxyvitamin D     

Job demands,decisional control,and cardiovascular responses

The demand-control model for coronary heart disease was tested using ambulatory blood pressure monitoring. Male patrol officers (N = 118) wore ambulatory blood pressure monitors during 1 of their day shifts with readings taken every 30 min. Following each reading, officers completed a questionnaire using a handheld computer. Significant interactions were obtained between job demands and decisional control for heart rate and pressure rate product such that both variables were highest under conditions of high demand and low control. Main effects were obtained for control such that diastolic blood pressure and mean arterial pressure were significantly higher under conditions of low control. These results support the demand-control model and emphasize the importance of psychological control in cardiovascular responses.     

Propranolol Medication among Coronary Patients: Relationship to Type a Behavior and Cardiovascular Response

Abstract

The present correlational study compared behavioral and psychophysiological characteristics of coronary patients who were either medicated or not medicated with the beta-adrenergic blocking drug propranolol. Eighty-eight patients were given a structured Type A interview (SI) and a history quiz while heart rate and blood pressure were monitored. Data were analyzed controlling for age, sex, extent of coronary artery disease, and history of angina. Results indicated that patients taking propranolol (n = 65) were significantly lower in intensity of Type A behavior than patients not taking propranolol (n=23). No effects were obtained for patients medicated or not medicated with diuretics, nitrates, or other CNS active drugs. Propranolol patients also showed lesser heart rate and rate-pressure product responses to the interview, but did not differ in blood pressure responses. Components of Type A which were lower in propranolol patients included speech stylistics (loud/explosive, rapid/accelerated, potential for hostility). Content of responses to the SI and scores on the Jenkins Activity Survey did not differ between the groups. An explanation for these results is offered in terms of the effects of propranolol on peripheral sympathetic responses, and evidence for a physiological substrate for Type A behavior. A conceptualization of the Type A pattern in terms of cognitive and physiological components is advanced, and implications for clinical intervention are discussed.     

Cardiovascular Responsivity, Type A Behavior, and Parental History of Heart Disease in Young Women

The purpose of this study was to examine the physiological responsiveness of Type A and Type B women during interpersonal and individual, competitive stressors. Extreme groups of Types A and B college-age women were monitored on heart rate and blood pressure while they engaged in an oral history quiz and the Stroop color/word test. Subjects were also subdivided by presence or absence of family history of coronary heart disease. Types A and B women did not differ on blood pressure levels or reactivity; Type A women did show a trend toward a greater increase in heart rate to the color/word task. Women with a positive family history had higher levels of systolic and a trend toward higher levels of diastolic blood pressure. There were no significant interactions of Type A/B with family history. Our conclusion is that Type A behavior is only very weakly, if at all, associated with physiological responsivity in young adult women.     

Components of hostility as predictors of sudden death and myocardial infarction in the Multiple Risk Factor Intervention Trial

We tested the hypothesis that hostility is associated with increased relative risk (RR) for coronary death and nonfatal myocardial infarction among participants in the prospective Multiple Risk Factor Intervention Trial (MRFIT). Cases (N = 192) were compared with matched controls (N = 384) on a variety of behavioral characteristics associated with the Type A behavior pattern (TABP), including three different but interrelated components of hostility. Logistic regression analyses revealed that only two of the eight TABP attributes analyzed on the overall sample were significant. Only total Potential for Hostility, when dichotomized into "low" and "high" categories, and the antagonistic interpersonal component of hostility (Stylistic Hostility) had positive unadjusted associations with coronary heart disease (CHD) incidence (RR = 1.7, p = 0.003; and RR = 1.5, p = 0.016, respectively). The global TABP and related paralinguistic attributes were not significantly related to CHD incidence. After adjustment for the traditional risk factors of age, serum cholesterol, blood pressure, and cigarette smoking, only dichotomous Potential for Hostility showed a significant relative risk (RR = 1.5, p = 0.032). Ordinal logistic regression revealed a nonsignificant effect.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cynical hostility relates to a lack of habituation of the cardiovascular response to repeated acute stress

Hostility is associated with increased risk for cardiovascular disease. Heightened cardiovascular reactivity to psychological stress has been proposed as a potential mechanism. Recent work has emphasized a need to measure cardiovascular reactivity across multiple stress exposures to assess potential habituation over time. The aims of the current study were (a) to examine the relationship between each of the three main components of hostility (i.e., emotional, cognitive, and behavioral) and cardiovascular reactivity at two separate stress testing visits and (b) to examine the relationship between hostility components and cardiovascular reactivity habituation. This study utilized previously collected data from the Pittsburgh Cold Study 3. One hundred and ninety-six participants (Mean (SD)[range] age = 29.9 (10.8)[18–55] years, 42.9% female, 67.3% Caucasian) completed 2 separate, identical laboratory sessions, consisting of a 20-min baseline and 15-min stress (Trier Social Stress Test). Heart rate and systolic/diastolic blood pressure were recorded throughout. Reactivity was calculated separately for heart rate, systolic, and diastolic blood pressure (stress—baseline). Participants also completed a modified version of the Cook-Medley Hostility Scale. Results indicated that greater cognitive hostility (i.e., cynicism) was associated with blunted cardiovascular reactivity at Visit 1 and less cardiovascular reactivity habituation between visits, even when controlling for confounding variables. No significant relationships to cardiovascular reactivity or habituation were found for emotional (i.e., hostile affect) or behavioral (i.e., aggressive responding) components. Outcomes for total hostility did not survive adjustment for confounders. These results identify a potential pathway through which hostility, particularly cynicism, contributes to disease risk.     

The numerical study on specialized treatment strategies of enhanced external counterpulsation for cardiovascular and cerebrovascular disease

Traditional clinical mode of enhanced external counterpulsation is not targeted for different diseases. Specialized strategies in the treatment of enhanced external counterpulsation for coronary heart disease and cerebral ischemic stroke are supposed to be distinguished. The goal of treatment for coronary heart disease is diastolic blood pressure/systolic blood pressure?=?Q?≥?1.2 after counterpulsation, while the goal of treatment for cerebral ischemic stroke is the improvement of mean arterial pressure. A computational lumped parameter model was established for the simulation of hemodynamic effect of enhanced external counterpulsation on two diseases. Vessel collapse was considered during the simulation of counterpulsation. Based on different pressurized and decompressed rate, pressurized moment, pressure duration, and pressure amplitude, different counterpulsation modes were applied to the model and the immediate hemodynamic effects were compared. Results showed that the pressure duration and pressure amplitude had most influence on two diseases. For cerebral ischemic stroke, the longer pressure duration and the higher pressure amplitude of thighs, the higher mean arterial pressure; while for coronary heart disease, the value of Q was highest when the pressure end moment was 0.6 s during a 0.88-s cardiac cycle, and Q had a linear increase in the pressure amplitude of buttocks, but little change with the increase of calves and thighs pressure amplitude. For patients with coronary heart disease, the pressure duration was not supposed to be too long to avoid the increase of systolic blood pressure, and the improvement of pressure amplitude of buttocks could promise a positive treatment effect for coronary heart disease. While for patients with cerebral ischemic stroke, both the long pressure duration of each part and the high pressure amplitude of thighs could result in the systolic blood pressure and diastolic blood pressure have a certain increase, thus promoting the maximum mean arterial pressure and a best treatment.

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Graphical abstract The specialized treatment strategies of EECP for cardiovascular and cerebrovascular disease

     

Differential hostility profiles accompany different hemodynamic response patterns

Cardiovascular reactivity has been proposed as a mechanism by which psychosocial variables may lead lo coronary heart disease. Although reactivity as a generalized response has been linked lo psychological factors, there are specific hemodynamic profiles that underlie blood pressure reactivity. This study characterized subsets of young adults as myocardial or vascular reactors, in response to three laboratory tasks: mental arithmetic, videogame, and anger recall interview. Vascular reactors had higher diastolic blood pressure increases to all tasks, whereas reactor groups were equivalent at rest and on systolic blood pressure responses. Correlational analyses were conducted to determine whether psychological dimensions are uniquely associated with myocardial or vascular reactors' cardiovascular responses, at rest and during acute stressors. For myocardial reactors, resting systolic blood pressure was higher in hostile and suspicious individuals, whereas reactivity was linked to impulsivity. For vascular reactors, low trust, low gregariousness, and high depression were associated with diastolic reactivity to tasks. The predictive validity of hostility, distrust, sociability, and depression for cardiovascular pathology may vary with reactor type.