Handbook of Psychology

Hypertension 353

TABLE 15.2 Studies of the Impact of Psychosocial Trials on Cardiac Events

Number of Patients Reduction in

Type of Control Intervention Psychosocial Cardiac End Reduction in

Study Patients Group Group F/U, y Type of Intervention Factors? Points Events?

Rahe et al., 1979 s/p MI 22 39 3 Group education and support Yes (for overwork; CD/MI Yes (P< 0.05)
time urgency)
Stern et al., 1983 s/p MI 20 35 1 Group counseling Yes (for depression) ACM; MI No
Friedman et al., s/p MI 270 592 4.5 TABP modi“cation and Yes (for TABP) CD/MI Yes (P< 0.005)
1984 group counseling
Horlick et al., s/p MI 33 83 0.5 Hospital-based education No (for anxiety; CD No
1984 program (6 wk) depression)
Patel et al., 1985 ≥2 RF 93 99 4 Breathing, muscle relaxation, Not assessed Angina; Small sample
meditation MI-1; CD
Maeland et al., s/p MI 1115 137 3.3 Educational program No (for anxiety; ACM No*
1987 depression)
Dixhoorn et al., s/p MI 46 42 2.5 Physiological relaxation Not assessed CD; MI; UAP; Yes (P0.05)
1987 (e.g., breathing, exercise) CABG
Frasure-Smith s/p MI 229 232 5 Home-based nursing Yes (for GHQ) MI; CD Yes (P 0.04
et al., 1989 intervention for MI•)
Thompson et al., 60 s/p MI 30 30 0.5 Group counseling Yes (for anxiety and ACM Small sample
1990 depression)
Nelson et al., 1994 s/p MI 20 20 0.5 Physiologic stress Manage- Yes (for ability to MI; ACM Small sample
ment (e.g., breathing) handle •stressŽ)
Burell et al., 1994 s/p MI 24 23 2 TABP modi“cation Yes (for TABP) CD/MI Small sample
Jones et al., 1996 s/p MI 1155 1159 1 Group sessions 7 wks for No (for anxiety; ACM; CD No
stress management and depression)
counseling
Blumenthal et al., CAD with 40 33 5 Structured group instruction Yes (for GHQ scores CD, MI, PTCA, Yes RR0.26
1997 EII with multiple stress and hostility) CABG (0.07...0.90)
reduction components
Frasure-Smith et al., s/p MI 684 692 1 Home-based nursing No (for anxiety; CD No
1997 intervention, to decrease depression)
transient increase in distress

RF indicates risk factors; EII, exercise-induced ischemia; TABP, Type A behavior pattern; MI-1, undocumented myocardial infarction; and UAP, unstable angina
pectoris.
*At 6 months of follow-up, short-term lower anxiety and death rate (P 0.05) in intervention group.

• At 1 year (length of intervention), P0.07 for CD reduction in intervention group.
  Source:Reprinted with permission from Rozanski et al. (1999). Circulation, 99,2192...2217.

pressure levels are correlated among family members and
more importantly they are correlated higher in blood related
relatives versus adopted family members (Ward, 1990). Al-
though research shows us the importance of genetics, the
proportion of high blood pressure caused by genetics alone is
dif“cult to determine because some risk factors, for example,
obesity and alcohol, are both environmentally and geneti-
cally in”uenced.
Population studies also reveal a higher incidence in
various cultures and socioeconomic groups that cannot be
explained by genetics alone (Henry & Cassel, 1969). For ex-
ample, African Americans have the highest proportion of
hypertension than any other group in the United States, but
hypertension prevalence among poor African Americans
is higher than among those in the middle class (Harburg et al.,
1973).

Role of Stress and Behavior

Many psychological and sociocultural studies have identi“ed

potential risk factors related to behavior that might play a role

in the development of hypertension. The increased risk of hy-

pertension for African Americans in the United States and

among persons of lower socioeconomic status has been at-

tributed to several factors, including dietary differences, ex-

ercise habits, and the social and physical characteristics of

the environment (Kreiger & Sidney, 1996). Some studies

have hypothesized that recurrent exposure to highly stressful

environments (e.g., urban high-crime settings) that require

constant vigilance and mobilization of coping resources may

raise blood pressure (Gutmann & Benson, 1971; Henry &

Cassel, 1969). One study of Detroit residents has explored

the role stress plays in hypertension (Harburg et al., 1973).