How many sphygmomanometric cuff inflations are necessary to obtain a hemodynamic baseline?

The purpose of this study was to determine the minimum number of consecutive blood pressure cuff inflations required to obtain seated stable resting baseline measurements of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Sixty male college students aged 18 to 31 years volunteered as study subjects. Thirteen observations of HR, SBP, DBP, and MAP were recorded at 90-second intervals for each subject using a Critikon-Dinamap monitor. Stable readings for SBP and MAP were obtained in 6.5 minutes or 3 to 5 cuff inflations in the population tested. Using this procedure, additional age- and gender-specific norms could be established for normal and hypertensive subjects. Knowing the approximate quantity and frequency of blood pressure cuff inflations needed to generate baseline minimum measurements of HR, SBP, DBP, and MAP will be helpful in studies of cardiovascular reactivity, as well as for clinical and psychophysiologic treatment of hypertension.

Speech rate, loudness, and cardiovascular reactivity.

This paper reports the results of two studies that investigated the relationship between speech rate, loudness, and cardiovascular reactivity (CVR). One study involved the separate manipulation of speech rate and loudness and assessed its effects on CVR during a routine reading task. The second study involved the simultaneous manipulation of both loudness and speech rate and studied its effects on CVR within the context of a personal interview. In both studies, the reduction of speech rate and/or loudness was associated with a significant reduction in CVR. On the other hand, increasing speech rate and/or loudness had no, or only a very minimal, effect on CVR. It is suggested that in the absence of emotional arousal, especially anger-arousal, rapid and loud speech per se is not associated with significant cardiovascular hyperreactivity. On the other hand, our findings suggest that training people to speak slowly and softly may be an effective approach for the control of cardiovascular hyperreactivity.

Gender differences in cardiovascular reactivity.

Pronounced cardiovascular reactivity to stress is a behavioral mechanism that may underlie the pathophysiology of coronary heart disease (CHD). Based on the greater incidence of CHD among males than among females, the purpose of the current investigation was to test the hypothesis that in young adults (ages 17-29), males (n = 47) show more cardiovascular reactivity than females (n = 61) to two stressors, a video game and cigarette smoking. Five of the six comparisons did not support the hypothesis: females were higher on heart rate and diastolic blood pressure reactivity to both stressors; males were higher on systolic blood pressure reactivity to the video game only. The results suggest that females may be particularly physiologically reactive to cigarette smoking.

Aerobic fitness, psychological characteristics, and cardiovascular reactivity to stress.

Examined the relations among aerobic fitness (AF), psychological characteristics, and cardiovascular reactivity using 62 men divided into highly fit and less fit groups based on a maximal treadmill exercise test. Several psychological and physiological variables were measured, and subjects' cardiovascular reactivity was assessed during a mental arithmetic task and during a video game task. Highly fit subjects showed a significantly smaller increase in both diastolic blood pressure (DBP) and heart rate (HR) and reported themselves to be less anxious and less angry than less fit subjects. Furthermore, controlling for subjects' scores on a scale assessing angry temperament reduced the relationship between AF and DBP reactivity to nonsignificant levels. These results suggest that degree of dispositional anger, which covaries with increased fitness, may contribute to the apparent relationship between AF and DBP--but not HR--reactivity.

Components of hostility as predictors of sudden death and myocardial infarction in the Multiple Risk Factor Intervention Trial.

We tested the hypothesis that hostility is associated with increased relative risk (RR) for coronary death and nonfatal myocardial infarction among participants in the prospective Multiple Risk Factor Intervention Trial (MRFIT). Cases (N = 192) were compared with matched controls (N = 384) on a variety of behavioral characteristics associated with the Type A behavior pattern (TABP), including three different but interrelated components of hostility. Logistic regression analyses revealed that only two of the eight TABP attributes analyzed on the overall sample were significant. Only total Potential for Hostility, when dichotomized into "low" and "high" categories, and the antagonistic interpersonal component of hostility (Stylistic Hostility) had positive unadjusted associations with coronary heart disease (CHD) incidence (RR = 1.7, p = 0.003; and RR = 1.5, p = 0.016, respectively). The global TABP and related paralinguistic attributes were not significantly related to CHD incidence. After adjustment for the traditional risk factors of age, serum cholesterol, blood pressure, and cigarette smoking, only dichotomous Potential for Hostility showed a significant relative risk (RR = 1.5, p = 0.032). Ordinal logistic regression revealed a nonsignificant effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Potential for hostility and dimensions of anger.

Recent reviews have linked Potential for Hostility derived from the Structured Interview (SI) to coronary artery disease, independent of the global Type A pattern. The present study examined the construct validity of Potential for Hostility ratings by correlating Potential for Hostility with 21 scales from four widely used anger/hostility measures: 7 scales from the Anger Self-Report, 8 scales from the Buss-Durkee Hostility Inventory, the total score from the Novaco Anger Inventory, and 5 scales from the Multidimensional Anger Inventory. The pattern of correlations revealed that Potential for Hostility was significantly related to scales reflecting awareness and arousal of anger, particularly the verbal expression of anger. To identify underlying anger dimensions, the 21 scales were factor-analyzed. Examination of two and three rotated principal components confirmed previous solutions. The first component, representing anger-arousing and -eliciting situations and anger awareness, was labeled Experience of Anger. The second component, consisting of scales dealing with either physical assault or verbal expression of anger, was labeled Expression of Anger. When a third factor was retained, it contained scales of suspicion, mistrust-suspicion, and guilt: It was therefore labeled Suspicion-Guilt. Potential for Hostility was correlated only with the Expression of Anger factor in the two-factor solution; in the three-factor solution, Potential for Hostility was correlated equally with the Experience of Anger and Expression of Anger factors but was not correlated with the Suspicion-Guilt factor. The implications of these results for the assessment of hostility are discussed.

Coronary prone behavior: components of the type A pattern and hostility.

Traditional and nontraditional risk factors for coronary heart disease (CHD) are discussed with special attention devoted to the Type A behavior pattern (TABP). Positive and negative epidemiological evidence bearing on the risk factors status of global TABP is reviewed. Results of the review suggest that component scoring of the multidimensional global TABP in attempts to uncover "toxic" components, particularly Potential for Hostility, is a profitable research strategy. Similarly, evidence is presented that suggests merit in component scoring of hostility, also a multidimensional construct. To explicate more fully the nature of Potential for Hostility and its categories, correlations between the SI-derived ratings and ratings of established dimensions of individual differences based on the five-factor taxonomic model of personality from subsamples of the MRFIT and WCGS studies are presented. Total Potential for Hostility and especially the Style of interaction category show highly significant relations to Low Agreeableness or Antagonism. High ratings of Potential for Hostility identify individuals who can be described as uncooperative, antagonistic, rude, disagreeable, unsympathetic, callous, and the like. Implications of the evolving concept of coronary-prone behavior, as distinguished from TABP, are briefly considered.

Exercise hypertension: behavior and the dynamic action of risk factors.

Epidemiological research identifies risk factors for coronary heart disease (CHD) to enable interventions to reduce the incidence of the disease. The twenty-year decline in cardiovascular-related deaths, however, cannot be explained solely by any pronounced changes in the classic risk factors (serum cholesterol, blood pressure and cigarette smoking) or related behaviors. Accordingly, it is apparent that there is much unexplained variance in the pathophysiology of CHD and that various behaviors are not associated with the classic risk factors in a simplistic fashion. Since acute and severe stress can affect thresholds for precipitation of cardiac events, the question of causality of long-term negative emotions has been repeatedly addressed; there is, however, no solid evidence that facets of neuroticism are related to documented acute coronary events while on the other hand, there is considerable evidence that emotionally maladjusted individuals have many complaints, including chest pain that is frequently labeled angina in spite of the absence of documented CHD. With regard to patterns of behavior in identifying risk factor status in CHD most attention has been focused on the Type A behavior pattern (hard-driving, job involvement, speed of activity, competitiveness, aggressiveness and mental and physical alertness). While this type of behavior has been related to clinical CHD independent of classic risk factors in some studies, the vast majority of epidemiological research has failed to replicate the association between the global Type A behavior pattern and any manifestation of CHD. Some attributes of the Type A behavior pattern, in particular, hostility, however, may be related to CHD even if the global pattern is not significantly associated.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of beta-adrenergic stimulation and blockade on cardiovascular reactivity, affect, and type A behavior.

The present study examined the acute effects of drugs that stimulate or block sympathetic nervous system activity on components of Type A behavior, affect, and cardiovascular responses to mental stressors. Either propranolol (a beta-adrenergic blocker), isoproterenol (a beta-agonist), or placebo was infused intravenously at different times in 12 healthy males. In two sessions, placebo (saline) was administered first, followed by a structured interview, challenging mental arithmetic test, and completion of affect scales. The procedure was then repeated with one of the active drugs, presented in counterbalanced order. Results indicated reliable drug effects on both heart rate (HR) and systolic blood pressure (SBP) reactivity to the tasks, with change scores to the tasks markedly increased by isoproterenol. Anxiety and hostility ratings paralleled results for HR and BP, with much of this effect being due to higher affect ratings for isoproterenol. The effect of the drugs on Type A behavior was unexpected, with global Type A and several components lowered by isoproterenol and unaffected by propranolol. These data are discussed in terms of the interfering effects of anxiety on Type A speech components. The influence of isoproterenol on affect and reactivity might reflect the physiologic action of a beta 2-adrenergic positive feedback loop which increases release of endogenous norepinephrine, and/or potentiating effects of emotion on reactivity to stress.

Components of hostility and the severity of coronary artery disease.

Previous research has linked various measures of hostility to the prevalence and incidence of coronary heart disease (CHD). The present study sought to determine whether some dimensions of hostility are differentially related to angiographically documented severity of coronary artery disease (CAD). Specifically, a hostility measure that correlates with indices of neuroticism was compared with a hostility measure unrelated to neurotic tendencies. For patients 60 years and younger, results were significant, revealing that neurotic hostility was inversely associated with severity of CAD whereas nonneurotic hostility scores were positively related to extent of disease. Overall hostility scores derived from the combination of the two kinds of hostility measures were unrelated to CAD severity. Results suggest that the multidimensional nature of the hostility construct should be appreciated in attempts to associate measures of hostility with manifestations of CHD.

Components of Type A, hostility, and anger-in: relationship to angiographic findings.

Previous research has linked the Type A coronary-prone behavior pattern to angiographically documented severity of coronary atherosclerosis (CAD). The present study sought through component scoring of the Type A Structured Interview (SI) to determine what elements of the multidimensional Type A pattern are related to coronary disease severity in a selected group of patients with minimal or severe CAD. Multivariate analyses controlling for the major risk factors showed no relationship between global Type A and extent of disease. Of all attributes measured, only Potential for Hostility and Anger-In were significantly and positively associated with the disease severity, including angina symptoms and number of myocardial infarctions. Further analysis revealed that Potential for Hostility and Anger-In were interactive in their association, such that Potential for Hostility was associated with disease endpoints only for patients who were high on the Anger-In dimension. These findings support previous research in suggesting that anger and hostility may be the critical aspects of the Type A pattern in predisposing individuals to risk of CAD.

Components of type A, hostility, and anger-in: further relationships to angiographic findings.

In a previous study of patients undergoing angiography at Duke University Medical Center, we reported that of all components of the Type A behavior pattern (TABP), only Potential for Hostility and Anger-In were significantly associated with extent of coronary artery disease (CAD). The present study was undertaken to replicate these findings using a different patient population. Tape-recorded structured interviews from 125 angiography patients at Massachusetts General Hospital were blind scored using the component scoring system employed in the Duke study. The results confirmed our previous findings. Global TABP was completely unrelated to extent of CAD, while Potential for Hostility and Anger-In were significant independent predictors of disease severity. These findings argue for a reconceptualization of the manner in which the TABP is defined and assessed.

Selective cardiovascular effects of stress and cigarette smoking in young women.

In an earlier study, we found that men who smoked a cigarette and then engaged in a mildly stressful activity (video game) evidenced pronounced increases in heart rate and blood pressure, which were approximately equal to the sum of the effects produced by either smoking alone or stress alone. In the present study, a 2 (smoke vs. sham smoke) X 2 (stress vs. no stress) factorial design was used to evaluate the impact of stress and smoking on the cardiovascular responses of young women. The results revealed that the combination of stress and cigarette smoking produced blood pressure and heart rate responses that were larger than the additive effects of smoking and stress taken separately.

Familial resemblance in components of the type A behavior pattern: a reanalysis of the California type A twin study.

Rosenman and colleagues reported no heritability of global Type A behavior assessed by the Structured Interview (SI) method, although some of the self-report scales correlated with global Type A behavior did have heritable components. Recent factor analyses of coded SI responses revealed four independent dimensions: clinical ratings, primarily of speech stylistics; and self-reports of pressured drive, anger, and competitiveness. It may be that some of these dimensions have a heritable base, whereas others do not. We report here reanalyses of the available SI responses from the Rosenman sample. In this subsample, tape recorded interviews with 80 monozygotic and 80 dizygotic twin pairs were scored for the extent of self-reported Type A behaviors, the major speech stylistics considered to be indicative of Pattern A, and the observable Type A behaviors (e.g., signs of hostility). Then scores for the major dimensions measured by the SI were calculated and scores for which there were sufficient data were subjected to twin analyses by the method of Christian et al. These analyses showed that individual differences in the clinical ratings factor and certain ratings loading on it--specifically, loudness of speech, competition for control of the interview, and potential for hostility--might have a heritable component. These results are discussed in the context of the importance of hostility as a predictor of subsequent coronary heart disease events as well as of total mortality, other data on the heritability of emotionality, and a temperament approach to understanding the origins of the Type A behavior pattern.

Desirability of control versus locus of control: relationship to paralinguistics in the type A interview.

David Glass has suggested that need for control is an important dimension underlying the Type A coronary-prone behavior pattern. However, this hypothesis has never been directly tested. Findings from the present study supported the hypothesis by showing a significant relationship between measures of desire for control and the Type A pattern as assessed by both the structured interview and questionnaire methods, and with Type A voice stylistics. In contrast, locus of control scores correlated only with the questionnaire-based measure of Type A, and were unrelated to desire for control scores, interview-defined Type A, and Type A noncontent speech characteristics. Some evidence suggests the hypothesis that autonomic nervous system arousal can create psychological discomfort that may serve to increase both need for control and Type A vocal stylistics. In addition, such vocal mannerisms may actually facilitate control of the social environment. Evidence implicating genetic factors in these processes is discussed.

Component analysis of the type A coronary-prone behavior pattern in male and female college students.

Two studies investigated the psychological dimensions encompassed by the Rosenman Structured Interview (SI) method of assessing the Type A behavior pattern. In Study 1, female students completed the SI and Jenkins Activity Survey (JAS). Factor analysis of the verbal stylistic and answer content components of the SI yielded a 5-factor solution, with one factor--Clinical Rating--accounting for most nonerror variance in Type A ratings. The remaining factors were derived from answer content and correlated more substantially with JAS Type A ratings than with SI Type A ratings. In Study 2, male and female college students completed the SI and JAS and a battery of questionnaires that tap trait dimensions implied by the conceptual definition of Type A. For both males and females, SI ratings of Type A could almost be completely predicted by scores on the Clinical Rating factor. For both sexes, content dimensions of the SI related to other measures of Type A and to Type A-consistent traits, whereas the Clinical Rating factor was only modestly associated with such traits. Moreover, sex differences were observed in the trait constellations composing SI and JAS definitions of Type A. These results suggest that a discrepancy exists between conceptual and operational definitions of the Type A pattern.

Selective cardiovascular effects of stress and cigarette smoking.

The purpose of the present study was to determine how cigarette smoking and psychological stress combine to affect cardiovascular function. Stress was operationally defined as playing a series of difficult video games under challenging instructional conditions. Following an initial test game, 51 smokers were randomly assigned to a 2 (smoke vs. sham smoke) X 2 (stress vs. no stress) design. The results showed that the subjects who sham smoked (inhaled unlit cigarettes) under no stress evidenced minimal changes in cardiovascular parameters. Subjects who smoked under no stress evidenced approximately 12 mmHg increase in systolic blood pressure (SBP) and 9 mmHg increases in diastolic blood pressure (DBP), and a 15 beat-per-minute increase in heart rate (HR). These effects were similar in magnitude to those seen in subjects who sham smoked under stress. By contrast, subjects who smoked under stress showed markedly larger increases in all cardiovascular parameters, approximately doubling the magnitude of the observed response over that seen with either smoking or stress alone. Correlational analyses suggested the presence of stable individual differences in autonomic lability or sensitivity. Possible mechanisms are suggested whereby stress and smoking may combine to heighten the risk for coronary disease.

Propranolol medication among coronary patients: relationship to type A behavior and cardiovascular response.

The present correlational study compared behavioral and psychophysiological characteristics of coronary patients who were either medicated or not medicated with the beta-adrenergic blocking drug propranolol. Eighty-eight patients were given a structured Type A interview (SI) and a history quiz while heart rate and blood pressure were monitored. Data were analyzed controlling for age, sex, extent of coronary artery disease, and history of angina. Results indicated that patients taking propranolol (n = 65) were significantly lower in intensity of Type A behavior than patients not taking propranolol (n = 23). No effects were obtained for patients medicated or not medicated with diuretics, nitrates, or other CNS active drugs. Propranolol patients also showed lesser heart rate and rate-pressure product responses to the interview, but did not differ in blood pressure responses. Components of Type A which were lower in propranolol patients included speech stylistics (loud/explosive, rapid/accelerated, potential for hostility). Content of responses to the SI and scores on the Jenkins Activity Survey did not differ between the groups. An explanation for these results is offered in terms of the effects of propranolol on peripheral sympathetic responses, and evidence for a physiological substrate for Type A behavior. A conceptualization of the Type A pattern in terms of cognitive and physiological components is advanced, and implications for clinical intervention are discussed.