Cardiovascular reactivity research examines the alterations in cardiovascular activities that occur in response to environmental circumstances considered stressful. While this reactivity is thought to be mediated by the sympathetic nervous system, there is considerable variation in the amount of reactivity displayed by different individuals in the same situation or even by the same individual in different situations. This lack of reproducibility of cardiovascular reactivity makes it challenging to study the effect of stress reduction interventions aimed at reducing it.
This paper focuses on stress reduction approaches to the prevention and management of hypertension. Most stress reduction approaches are aimed at decreasing the stress response, possibly by decreasing cardiovascular hyperreactivity. Indeed, aerobic exercise, social support, biofeedback, and relaxation have each been shown to reduce stress reactivity in the laboratory. Yet, this literature is plagued with numerous problems making interpretation difficult. First, numerous behavioral strategies aimed at reducing stress and its physiological impact are available. Because responses to these strategies vary greatly among individuals, they are almost always used in combination with one another or with antihypertensive medications. This makes it impossible to identify specific effects. Secondly, most of these interventions require learning new skills to a preset criterion. The literature is inconsistent in reporting whether subjects successfully learn these skills and can use them effectively outside the learning environment. We have only begun to test whether the effect of these interventions can generalize outside a strictly controlled study setting. Third, studies on these interventions are time consuming and underfunded, and therefore involve small numbers of subjects. Finally, outcome measures for stress reduction interventions typically involve laboratory assessment of resting BP without considering the possible intervening mechanism, including whether or not they alter cardiovascular reactivity. Therefore, questions remain about whether cardiovascular hyperreactivity can be modified in persons with hypertension. Alternatively, chronic cardiovascular hyperreactivity may produce changes in cardiovascular structure that may not respond to stress reduction interventions.
This presentation will summarize the recent literature on the effect of those interventions aimed at modifying the effect of stress on the central nervous system and cardiovascular reactivity, such as cognitive behavioral modification and physiological self-awareness (biofeedback). The evidence and suggestions for incorporating these interventions into care of persons with hypertension will be provided. Finally directions for future research in this area will be proposed.
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