Studies in hypertension

Abstract This paper has dealt with the role of psychologic factors in hypertension. The discussion considers what associations between psychologic factors and hypertension have been postulated and then considers the manner of their association. 1. a. It is suggested that hypotheses as to the association between psychologic factors and hypertension can be placed into three classifications: those emphasizing the whole configuration of characteristics making up the so-called hypertensive personality; those considering specific psychologic conflicts as the unit of psychologic description; and those dealing with conditions of psychologic stress. 2. b. Reseach bearing on each of these general hypotheses has been described and evaluated from a methodologic standpoint. 3. c. Five different approaches to the manner in which psychologic factors are thought to be associated with hypertension have been discussed. These are: 1. 1. The sequences involved are not considered explicitly in the formulation of the hypotheses. 2. 2. The psychologic factors precede and are responsible for the pyschologic mechanisms which culminate in the development of hypertension. 3. 3. The initial conditions are provided by genetic factors with the subsequent introduction of specified psychologic conditions precipitating physiologic mechanisms culminating in the development of hypertension. 4. 4. Particular environmental factors are prerequisite to the experience of psychologic conditions which in turn are followed by physiologic mechanisms culminating in hypertension. 5. 5. Physiologic factors are primary. The hypertensive disorder as well as associated psychologic conditions are secondary results of the initial presence of specified physiologic factors. From this appraisal of the literature, it seems plain that there is a sufficient basis for the proposition that psychologic factors play some role in the onset or dev elopment of hypertension to warrant its further exploration. The question is how this can be accomplished most effectively. Undoubtedly, a variety approaches are feasible and worth trying. Among these it would appear that a long-term, epidemiologic study of hypertension could make a significant contribution in this regard. It seems clear that one of the primary weaknesses of current research in this area is that it fails to take the factor of time into account. A long-term study would seem to provide a means for coming to understand the temporal element in the various relationships of psychologic factors to hypertension which have been postulated. In addition, since such a study would involved observations of nonhypertensive as well as hypertensive individuals, the appropriate controls could be incorporated in its design. It is evident, however, that formidable difficulties of definition and measurement remain to be solved before a study of psychologic factors can be fruitfully explored in a long-term study of hypertension. Research instruments applicable to field conditions which would allow the classification of subjects along variety of psychologic dimensions are simply not available. Experimental studies of a complex kind, therefore, seem a prerequisite to the development of the kind of research instruments which would be required to make feasible the testing of the extant hypothesis on the psychologic component in hypertension in a long-term field study of the disorder.