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The Effect of Inhibition of Hostility on Blood Pressure in Stressed Alzheimer Caregivers

出版	University of California, San Diego, 1998
URL	http://books.google.com.hk/books?id=JW1dodYlKlwC&hl=&source=gbs_api

註釋This study investigated whether the combination of chronic stress-induced hostility and emotional inhibition in older adults leads to increased hypertension risks that are mediated by increased plasma levels of adrenocorticotropic hormone (ACTH), cortisol, and neuropeptide Y (NPY). In Study 1, resting blood pressure (BP) of spousal caregivers of Alzheimer's Disease (AD) patients (N = 103) was assessed at home and a blood sample drawn by a visiting nurse every six months for up to seven years. Radioimmunoassays provided estimates of plasma neuroendocrine levels (ACTH, cortisol, and neuropeptide Y). In Study 2, ambulatory BP data were collected on a subset of caregivers (N = 38) for a single 24-hour period. Measures of caregiving demands, emotional expressiveness, social desirability, and hostility were administered. Hostile ideation was more prevalent among younger and newer caregivers and those encountering more dementia problem behaviors. Emotional expressiveness, which was highest among caregivers with mildly demented spouses, was negatively correlated with diastolic, but not systolic BP. Hostility was unrelated to BP in cross-sectional analyses, but a lower report of hostility was associated with a greater risk of hypertension longitudinally. The hypothesized interaction of high hostility and low emotional expressiveness to produce elevated BP was not supported. This interaction, however, predicted lower levels of circulating ACTH. Cortisol and NPY levels were not explained by either emotional expressiveness, hostility, or their interaction. A multivariate model comparison did not support the mediating influence of neuroendocrines to produce elevated BP. Mean ambulatory daytime BP was significantly higher than resting BP taken at home. The interaction of low emotional expressiveness and low hostility marginally predicted elevated systolic mean daytime BP. BP variability was not significantly related to emotional expressiveness or hostility. Conclusions were that among caregivers, both low emotional expressiveness and the absence of hostility while experiencing chronic stress may be independent risk factors for hypertension. Higher levels of circulating ACTH may be an indication of overexcitation of the HPA stress response in inhibited caregivers who report no hostile ideation in conjunction with caregiving.