Thursday, September 26, 2002: 2:45 PM-4:15 PM | |||
Cardiovascular Hyperreactivity and Hypertension Development: Directions for Nursing Research and Practice | |||
| There is a long history of nursing research that examines the effects of stress on health. Nurse investigators have applied stress and coping frameworks to their scientific work in many areas, including cardiovascular disease. Studies over the past three decades have provided increasing evidence that physiologic responses to stress play an important role in the development of essential hypertension (HTN). To date, the vast majority of studies examining the relationship between stress and the development of HTN have attempted to precipitate a physiologic cardiovascular response (referred to as cardiovascular reactivity, or CVR). Exaggerated CVR, or 'hyperreactivity' has been widely embraced as a potential marker of, and causal factor in, the risk of developing established HTN. Given this, CVR may eventually be used clinically to identify and possibly treat HTN at much earlier stages of disease progression. A common theme among the four presentations that comprise this symposium is the role of CVR in determining both future risk of HTN, as well as its potential as a marker to indicate effective management of established HTN or disease regression.
There are two important theoretical paradigm shifts that have occurred in this area of scientific inquiry over the past few years that are reflected in the symposium presentations. The first is a shift from stress frameworks that have reflected stressors as acute and self-limiting, but recurring. The two most widely utilized frameworks--Selye's general adaptation syndrome and Lazarus and Folkman's stress and coping framework--reflect this assumption to different degrees. Use of these frameworks has limited, however, investigation into the effects of chronic stress. A relatively new framework, the Allostatic Load model, developed by McEwen, will be presented and discussed in the session overview. In relation to these different models, the challenges of generalizing CVR from acute, laboratory stressors to commonly encountered stressors in the natural environment are further discussed by symposium presenters. The second shift that has occurred by the scientific community with regard to the role of CVR and HTN development is an increasing awareness that reactivity models cannot examine "reactivity" separate from, or removed from, "context." Recent reviews in the literature have highlighted the trajectory of scientific thought regarding CVR in four stages, which are: 1) person specific -- an entirely "trait" or "genetic" marker of risk, and generalizeable across stimuli, Clearly, as thought has evolved in stress-related determinants of HTN, reactivity models have moved from simplistic to more complex, with a greater awareness of the importance multiple factors being involved. Three of the presentations that comprise this symposium focus on specific aspects of reactivity models: physiological mechanisms involved in CVR and HTN development, the role of emotional/psychological influences on CVR, and behavioral modification techniques hypothesized to reduce the effects of stress on blood pressure among borderline hypertensives, possibly through reductions in CVR to stress. The last presentation describes a multifactoral model for examining long term, or chronic effects of stress on HTN development within the context of chronic stress as a possible contributor of cardiovascular disease disparities by social and economic factors. Together, these presentations provide participants with an overview of the state of the science in this field of inquiry, demonstrate how different aspects of CVR in the development of HTN can be applied in nursing research, and make recommendations for future nursing research and practice. | |||
| Organizer: | Shawn Kneipp, ARNP, PhD, Assistant Professor | ||
| Biological Mechanisms Mediate Reactivity and Hypertension: A Critical Analysis and New Insights Pei-Shan Tsai, PhD, research assistant professor | |||
| Cardiovascular Reactivity: The Role Of Anger and Hostility Mary S. Webb, RN, PhD, associate professor | |||
| Evidence-Based Practice: Stress Reduction Approaches for Managing Hypertension Carolyn B. Yucha, RN, PhD | |||
| Interactive Models of Hypertension: Environment, Person, and Situation Shawn Kneipp, ARNP, PhD, assistant professor, Samantha Malloy, RN, BSN, Doctoral Student | |||
The Advancing Nursing Practice Excellence: State of the Science