Elsevier

Physiology & Behavior

Volume 77, Issues 4–5, December 2002, Pages 699-704
Physiology & Behavior

Psychosocial demands and ambulatory blood pressure: a field assessment approach

https://doi.org/10.1016/S0031-9384(02)00921-6Get rights and content

Abstract

Ambulatory blood pressure (ABP) has been shown to have independent prognostic value, over and beyond the effects of clinic blood pressure (CBP) measures. We have examined the role of psychosocial demands in understanding ABP, using an electronic diary to measure ongoing experience in the field at the time of each blood pressure reading (ecological momentary assessment). In our previous work, several psychosocial factors were shown to be associated, within-person, with acute fluctuations in ABP in a healthy adult sample. Here, we replicate these findings in a new sample, and we also examine associations of the same variables with mean ABP (between-person) over a 6-day period. Five measures assumed to be markers of psychosocial demands (negative affect, arousal, task demand, decisional control, and social conflict) were shown here to be independently associated with ABP fluctuations during daily life, after adjustment for posture, activity, and substance use. Two of these, measures of task demand and decisional control, were also associated with mean ambulatory systolic blood pressure (SBP), and these latter associations persisted after controlling for CBP. These results support the possibility that psychosocial factors may account for some of the unique predictive value associated with ABP, and they support the value of these field assessment methods.

Introduction

Numerous findings have linked psychosocial factors with increased cardiovascular disease (CVD) risk. Factors such as job stress, hostility and the Type A behavior pattern, depression, and social isolation have been significantly associated with CVD incidence in healthy individuals, and with worsened prognosis in patient samples [1]. Biological alterations associated with psychosocial demands might play an important role in explaining some of these results. For example, hemodynamic and neuroendocrine changes associated with recurrent or chronic activation of the sympathetic nervous system have been shown to trigger pathophysiologic processes relevant to CVD risk [2].

With the advent of ambulatory blood pressure (ABP) monitoring, we can reliably assess cardiovascular activity in the natural environment. ABP measures may allow us to capture some of these disease-relevant biological alterations, associated with acute and chronic psychosocial demands, during periods of daily life when the experience of demanding activities or experiences are most likely to occur [3].

A large body of evidence supports the prognostic utility of mean ABP measures as correlates of disease risk, with such measures showing independent predictive value over and beyond the effects of blood pressure measures taken in the doctor's office [4]. As an explanation for these findings, some have suggested that ABP may reflect the influence of psychosocial factors, such as job stress, that can only be captured in the field and are not represented in the clinic [5]. In an effort to understand such influences, we have adopted ecological momentary assessment methods, which permit us to measure ongoing behavior in real time and in the natural environment [6]. One goal of our work has been to identify dimensions of daily experience that are associated with acute and chronic alterations in ABP, and ultimately, with cardiovascular health.

In our lab, we have developed a computer-assisted self-report diary, designed to assess psychosocial processes occurring in the natural environment that are hypothesized to be related to ABP [7]. The use of an electronic diary is important, as research suggests that many paper diaries are not completed at the time indicated [8]. Our diary includes five scales measuring dimensions of daily experience that are assumed to be markers of adaptive demands: social conflict, assessing the presence of negative social interactions with others; task demand and decisional control, assessing effortful and uncontrollable activities during daily life; and negative affect and arousal, assessing fluctuations in emotional activation. We use the term “psychosocial demands” to refer, in the aggregate, to these measures.

In a previous sample of healthy young adults, we found that changes in negative affect and arousal were positively associated with fluctuations in both systolic and diastolic blood pressure (SBP and DBP, respectively) during daily life (“within-person” effects), after adjustment for posture, activity, and substance use. Similar findings of a smaller magnitude emerged for the measures of task demand and decisional control. The magnitude of association between psychosocial demands and blood pressure varied significantly across individuals in this sample, with some showing larger changes in ABP than others, across comparable changes in perceived psychosocial demands [9].

Although these initial results have implications for understanding the short-term influence of psychosocial demands on cardiovascular function, longer term influences, which one would expect to be associated with individual differences in mean ABP, might be more directly relevant to the literature on CVD risk. With this in mind, we designed the present report as a replication and extension of our initial findings. As in our previous study, we hypothesized that five dimensions of psychosocial demands would be associated with acute within-person fluctuations in ABP. As an extension of our previous findings, we hypothesized that individual differences in psychosocial demands (“between-person” effects) would be associated with mean ABP over and beyond their association with clinic blood pressure (CBP) measures. Such effects would reflect associations that are uniquely relevant to blood pressure in the natural environment. In testing these associations, we will be expanding our understanding of the potential links between psychosocial factors and CVD risk.

Section snippets

Participants

Participants were 340 older adults drawn from the Pittsburgh Healthy Heart Project, an ongoing investigation examining biobehavioral predictors of subclinical CVD progression in an asymptomatic, community-dwelling sample. This study received the approval of the Institutional Review Board at the University of Pittsburgh, and participants were paid US$200 for completion of this portion of the research. Recruitment involved targeted mailings and media postings in the Pittsburgh metropolitan area.

Data quality

An average of 112.2 diary interviews (82% of possible interviews during waking hours; range=76–161) were successfully completed by each subject, and an average of 114.0 (83% of possible; range=80–191) blood pressure readings were collected. The average participant in this sample had 106.1 valid observations (range=66–148 observations with valid interviews and blood pressure readings) across the two ambulatory monitoring periods.

Correlations between measures of psychosocial demands

Between- and within-person correlation coefficients were derived

Discussion

Using a field assessment approach, we have examined several measures of “psychosocial demands” in terms of their association with ABP in a sample of healthy older community adults. On a within-person basis, everyday fluctuations in negative affect, arousal, social conflict, task demand, and decisional control were each associated with changes in cardiovascular activity, as predicted, even after statistical adjustment for posture, activity, and substance use. On a between-person basis, those

References (19)

  • A. Rozanski et al.

    Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy

    Circulation

    (1999)
  • S.B. Manuck et al.

    The behavioral exacerbation of atherosclerosis and its inhibition by propranolol

  • T.G. Pickering

    The effects of environmental and lifestyle factors on blood pressure and the intermediary role of the sympathetic nervous system

    J. Hum. Hypertens.

    (1997)
  • P. Verdecchia

    Prognostic value of ambulatory blood pressure: current evidence and clinical implications

    Hypertension

    (2000)
  • R.B. Devereux et al.

    Left ventricular hypertrophy in patients with hypertension: importance of blood pressure response to regularly recurring stress

    Circulation

    (1983)
  • A.A. Stone et al.

    Ecological momentary assessment (EMA) in behavioral medicine

    Ann. Behav. Med.

    (1994)
  • T.W. Kamarck et al.

    The Diary of Ambulatory Behavioral States: a new approach to the assessment of ambulatory cardiovascular activity

  • A.A. Stone et al.

    Patient non-compliance with paper diaries

    BMJ

    (2002)
  • T.W. Kamarck et al.

    Effects of task strain, social conflict, and emotional activation on ambulatory cardiovascular activity: daily life consequences of recurring stress in a multiethnic adult sample

    Health Psychol.

    (1998)
There are more references available in the full text version of this article.

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    Work has also been done to develop/apply algorithms to detect stress from cardiovascular and respiratory parameters in different populations of substance users (Hovsepian et al., 2015; Rahman et al., 2014; Sarker et al., 2016), as well as to detect craving in smokers by interactions among craving, stress, and time of day (Chatterjee et al., 2016). Considerable work in non-substance-users has also been done on stress and negative emotions, given their links to cardiovascular disease, as well as how potential protective factors (e.g., self-esteem, relaxation, positive social interactons) could buffer the cardiovascular effects of negative events (Brondolo et al., 2008; Enkelmann et al., 2005; Gump, Polk, Kamarck, & Shiffman, 2001; Kamarck et al., 2002, 2005, 1998; Ottaviani et al., 2015; Plarre et al., 2011; Schwerdtfeger & Scheel, 2012; Verkuil et al., 2015). These results could also be relevant to coping in substance users.

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1

Saul Shiffman is cofounder and Chief Science Officer of invivodata, inc., which provides electronic diary methods like those reported here for use in clinical trials.

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