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Behavioral medicine approaches to hypertension: An integrative analysis of theory and research

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Abstract

This article compares behavioral and biological approaches to hypertension, highlights some of the practical, semantic, and theoretical issues involved, and attempts a constructive, behavioral medicine integration of these approaches. The major behavioral approaches to hypertension are described, with a focus on their conceptual limitations as stimulants to research into psychobiological mechanisms. A biobehavioral systems analysis of hypertension is outlined, emphasizing the role of the central nervous system as a common pathway relating environmental and behavioral factors to cardiovascular regulatory dynamics and disease. Schwartz's concept of blood pressure disregulation is discussed, by which behavioral “feedback loops” may be included in the pathogenesis of homeostatic disorders. A detailed discussion of concepts underlying the clinical pharmacological approach to hypertension is provided; parallels are drawn between the conceptual framework and the theoretical and practical questions facing behavioral researchers concerned with hypertension. Synergistic interactive effects of drug and behavioral treatments are proposed. A biobehavioral overview, which links pressor and depressor stimulus patterns to both pathogenesis and therapy, can serve to integrate the previous biobehavioral systems analysis, the conceptual framework of clinical pharmacology, and the notion of biobehavioral disregulation of blood pressure. Implications for future behavioral medicine research in hypertension are provided.

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Authors and Affiliations

  1. Departments of Psychology and Psychiatry, Yale University and Yale University School of Medicine, 06520, New Haven, Connecticut

    Gary E. Schwartz

  2. Department of Medicine, University of Pittsburgh School of Medicine, 15261, Pittsburgh, Pennsylvania

    Alvin P. Shapiro

  3. Division of Neuropsychiatry, Walter Reed Hospital, 20012, Washington, D.C.

    Daniel P. Redmond

  4. Office of Health, U.S.A.I.D., 20023, Washington, D.C.

    Donald C. E. Ferguson

  5. School of Public Health, University of California, 94720, Berkeley, California

    David R. Ragland

  6. Behavioral Medicine Branch, Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, 20014, Bethesda, Maryland

    Stephen M. Weiss

Authors
  1. Gary E. Schwartz
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  2. Alvin P. Shapiro
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  3. Daniel P. Redmond
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  4. Donald C. E. Ferguson
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  5. David R. Ragland
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  6. Stephen M. Weiss
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Additional information

This review was prepared by an Ad Hoc Committee appointed and supported by the National Heart, Lung, and Blood Institute, Department of Health, Education, and Welfare. The views expressed herein are those of the authors and do not necessarily reflect those of either the Institute or the Department of Defense.

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Schwartz, G.E., Shapiro, A.P., Redmond, D.P. et al. Behavioral medicine approaches to hypertension: An integrative analysis of theory and research. J Behav Med 2, 311–363 (1979). https://doi.org/10.1007/BF00844739

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