HYPERTENSION-BEHAVIOR MEDICAL APPROACH Introduc

HYPERTENSION-BEHAVIOR MEDICAL APPROACH

Behavioral medicine is an integration of empirical knowledge from interdisciplinary research. It encompasses a recognition of the reciprocal nature of relationships between human biology, psychology, and sociology. Many behavioral factors are related to hypertension. Hypertension is often referred to as the silent killer; many are unaware that they have it, and persistent high blood pressure, not brought under control, is a risk for cardiovascular disease. Personality type, sociocultural mobility and membership, situational stress, somatic strain, health maintenance, coping styles and levels and modes of emotional release of anger, are all behavioral medical aspects to consider in the study of causes of hypertension. Initial blood pressure levels are considered the strongest predictor of future hypertension, however, many other factors are predictors as well. Family history, resting blood pressure, resting heart rate, body weight, and hemodynamic response to physiological and psychological stimuli are also considered. Nonpharmacologic management is the first-line treatment for mild hypertension; lifestyle interventions may then need to be combined with drug therapies (Cottrell, 1995; Eaton, McQuade, & Glupczynski, 1994; Gentry, 1984; Lenfant & Savage, 1995; O'Connor, Manson, O'Connor, & Burine, 1995).

Edwards (1995) reports that scientists anticipate the causes of hypertension to involve a

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nce index. Severe hypertension results in left ventricular dilation, subnormal cardiac index, and even higher total peripheral resistance index (Korner, Jennings, Esler, & Broughton, 1987). Frohlich (1995) reports that more than 22 years have passed since the National High Blood Pressure Education Program issued its first Joint National Committee report on detection, evaluation and the treatment of hypertension. A recent publication of the Committee's fifth report, offers innovations with a new classification of hypertensive disease, and statements dealing with initial and preferable therapy for the hypertensive patient. Stage I hypertension (systolic pressures ranging from 140 through 159 and diastolic pressures from 90 through 99 mm Hg), should have their pressure elevation controlled. Patients with lesser diastolic pressure elevations may be treated with lifestyle modifications or nonpharmacologic approaches. This would include control of body weight to within 15 percent of optimal weight and restriction of dietary sodium intake, cessation of smoking and restriction of ethanol intake, and increased exercise. If results are not found in three to six months, antihypertensive drug treatment programs are indicated. Anti

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