339Treatment of Essential Hypertension 354
Adherence to Treatment 356
Summary 356
CONCLUSION 356
REFERENCES 357Chronic diseases of the cardiovascular system, which in-
clude coronary heart disease (CHD), high blood pressure,
and stroke, constitute a major public health problem and the
leading cause of death in Western countries (American
Heart Association, 1999). Many physiological, environmen-
tal, and behavioral variables interact in the development of
these disorders. For example, many of the causal agents for
CHD can be modi“ed, relate to habits of living, and are
under the control of the individual. Therefore, coronary
heart disease can be thought of as a disorder that is a result
of the individual•s lifestyle, and it is not surprising that
cardiovascular diseases have been among the most widely
studied topics in health psychology (see for example,
Baum, Gatchel, & Krantz, 1997; Krantz, Grunberg, &
Baum, 1985).
In the United States, CHD continues to be a leading cause
of morbidity and mortality. The Center for Disease Control
(1996) reports one in “ve deaths are attributed to this disease
process with more men than women and more African
Americans than any other group dying from CHD. It is the
leading cause of death for men by the age of 45 and for
women by the age of 65. The speci“cs of the relationship be-
tween gender, race, and CHD will be discussed in greater de-
tail later in the chapter.
A dramatic decline in mortality from CHD has been seen
in the last 40 years. Since 1960, CHD mortality has declined
2% a year in this country. Both lifestyle changes, including
diet and exercise, and improvements in the management of
the disease medically, such as drug treatment and technology,
are responsible for this decline. The epidemiologic literature
estimates that greater than half (54%) of the decline between
1960 and 1985 is attributed to lifestyle changes, speci“cally
reductions in cholesterol intake and levels (30%) and cessa-
tion of cigarette smoking (24%) (Goldman & Cook, 1984,
1988). The WHO-Monica study (Tunstall-Pedoe, 2000) ex-
amined mortality from CHD in diverse populations and
found declines attributed both to secondary prevention and
advances in treatment, supporting the important link between
lifestyle and risk of developing CHD.
This chapter provides a selective overview of behavioral
science contributions to understanding the etiology and treat-
ment of two of the major cardiovascular disorders, coronary
heart disease and essential hypertension. For comprehensive
reviews of various aspects of this vast literature, see Allan
and Scheidt (1996), Ockene and Ockene (1992), Rozanski,
Blumenthal, and Kaplan (1999), Shumaker and Czajkowski
(1994), Dubbert (1995), and Julius and Bassett (1987).The opinions and the assertions contained herein are those of the
authors and are not to be construed as those of USUHS, the U.S.
Department of Defense, or the NIH. Preparation of this chapter was
supported by grants from the NIH (HL47337) and USUHS
(G172CK). Portions of this chapters were adapted from •Cardiovas-
cular DisordersŽ in D. S. Krantz and N. R. Lundgren, Comprehen-
sive Clinical Psychology.Alan S. Bellack and Michel Hersen, eds.
New York: Pergamon, 1998.
CHAPTER 15
Coronary Heart Disease and Hypertension
MARK O•CALLAHAN, AMY M. ANDREWS, AND DAVID S. KRANTZ
CORONARY HEART DISEASE 340
Risk Factors for CHD 340
Psychosocial Risk Factors 340
Individual Characteristics as CAD Risk Factors 345
Treatment of Coronary Heart Disease 348
Psychosocial Treatment Approaches/Implementation of
Lifestyle Changes 349
HYPERTENSION 352
Genetic and Environmental Interactions 352
Role of Stress and Behavior 353