Identifying momentary influences on ambulatory blood pressure (ABP) will help explain ABP variability; however, most research only examines aggregate ABP at the between-person level. This study used within-person methods to examine whether affective dimensions-valence and arousal-differentially predicted momentary ABP levels. A community sample (n = 39) wore an ABP cuff that took BP measurements every 20 min for 24 h. At each measurement, participants reported levels of valence and arousal on electronic diaries. Multilevel modeling was used to examine the effects of momentary and person-averaged levels of valence and arousal on ABP. Greater momentary negative valence and arousal predicted higher systolic BP compared to more positive or lower arousal assessments; higher averaged levels of arousal predicted higher DBP. The results suggest the independence of the effects of valence and arousal on BP. These findings have important implications for designing interventions to lower ABP.

Ambulatory blood pressure (ABP) has long been recognized by researchers as the gold standard of blood pressure (BP) measurement. Researchers and clinicians typically rely on the mean measure of ABP; however, there is considerable variability in the beat-to-beat BP. Although often ignored, this variability has been found to be an independent predictor of cardiovascular disease and mortality. The aim of this paper is to provide a conceptual review of ABP variability (ABPV) focusing on the following: associations between ABPV and health, whether ABPV is reliable, how to calculate ABPV, predictors of ABPV, and treatments for ABPV. Two future directions are discussed involving better understanding ABPV by momentary assessments and improving knowledge of the underlying physiology that explains ABPV. The results of this review suggest that the unique characteristics of ABPV provide insight into the role of BP variability in hypertension and subsequent cardiovascular illness.

Objective

We examined the mechanisms that underlie the observed relationships between loneliness and depressed mood and poor sleep quality in college students. This study was the first to investigate whether rumination and trait anxiety are psychological mechanisms that mediate this relationship.

Methods

In Study 1 (n = 1,244), using factor analysis with cross-sectional data, we established that loneliness and rumination are distinct constructs. We then collected survey data in two cross-sectional samples (ns = 300 and 218) and one prospective (n = 334) sample to test whether rumination and anxiety were mediators of the relationship between loneliness and depressed mood and poor sleep quality. Structural equation modeling was used to test the proposed relationships. Participants completed self-report measures of loneliness, rumination, trait anxiety, depressed mood, and sleep quality. In addition, measures of hostility, neuroticism, negative affect, and tobacco use were also assessed and tested as mediators, while social support was assessed and tested as a moderator.

Results

Consistent across the three studies, we found that rumination and trait anxiety fully mediated the associations between loneliness and depressed mood as well as poor sleep quality; these relationships held after testing all other factors.

Conclusion

This study helps explain how loneliness dynamics relate to poor health and suggests specific points of departure for the development of interventions.

Background

Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for BP measurement, compared to clinic BP measurements (CBP), which are a less valid predictor of target organ damage and cardiovascular events. However, ABPM is considerably more expensive than CBP, leaving BP researchers with a difficult dilemma: Use the less efficient CBP measure, or bear the cost of the more expensive ABPM. Recent developments in missing data methods, notably the two-method measurement (TMM) design, address this problem. With the TMM design, all research participants receive the less expensive CBP measure, but only a random subset receives the more expensive ABPM. The total number of participants must be increased, with additional participants receiving only CBP measurements. Even so, the TMM still reduces costs.

Methods

We applied the TMM approach, which makes use of a "bias correction" structural equation model, to an empirical data set in which data were available for ABPM and CBP, as well as an echocardiographic measure of left ventricular mass (LVM).

Results

Based on an estimated fivefold difference in cost for using ABPM compared to CBP, we found that statistical power can be considerably increased, or that BP measurement costs can be considerably reduced, when using this planned missing data design.

Conclusions

These benefits were observed with no loss of predictive validity (i.e., the observed association between BP and LVM). This suggests that the TMM design is a promising technique that in some studies may be able to decrease costs and/or increase one's power to detect effects.

Objectives

The purpose of this study was to validate the ScottCare 320 ambulatory blood pressure monitor (ABPM) using both group-level and individual-level validation procedures. The group-level validation followed a modified protocol of the European Hypertension Society's validation protocol. The individual-level validation was conducted to ensure that the monitor is valid from both a research and clinical perspective.

Methods

Participants (n=41) had three simultaneous blood pressure (BP) measurements taken by a trained listener using a mercury column sphygmomanometer and the ScottCare ABPM, which was used to validate the monitor at the group-level and the first half of the individual-level validation (i.e. the difference between the ABPM and auscultatory means for each participant <5 mmHg). The second half of the individual-level validation occurred by examining participants' responses on diary questionnaires taken immediately following the BP measurements (i.e. can extreme or deviant BP values be explained by situational factors).

Results

At the group level, the ABPM passed the criteria laid out by the European Hypertension Society. At the individual level, the difference between the auscultatory and ABPM means was less than 5 mmHg for both systolic and diastolic BP for 36 participants on the initial attempt, and the remaining five on the second attempt. Furthermore, the deviant values were largely attributed to explainable causes, mainly movement.

Conclusion

The ScottCare ABPM is a highly accurate monitor that can be considered valid at both the group and the individual level, and thus appropriate for both clinical and research use.

Background

A range of nonpharmacological interventions (e.g., meditation) have positive effects on blood pressure (BP) but tend to have poor adherence. These interventions may lower BP partly by absorbing and directing attention away from one's negative thoughts. We hypothesized that recurring self-selected activities (SSAs) that are attentionally absorbing may similarly lower BP. We examined the effect of reported engagement in SSAs during the previous month prior to participation on ambulatory BP (ABP) and whether those prone to rumination were less likely to show these effects.

Methods

Participants (n = 38) reported engagement in SSAs and how absorbing they were, responded to trait rumination and perceived stress questionnaires, wore an ABP monitor for 24 hours, and at each ABP measurement answered electronic diary questions assessing activity levels, affect, social interactions, and caffeine and tobacco use.

Results

Regression analyses tested whether the reported absorption of SSAs, trait rumination, and their interaction predicted daytime and nighttime systolic and diastolic ABP. Greater absorption predicted lower daytime and nighttime ABP (bs = -18.83 to -8.79; Ps < .05), but this relationship was moderated by trait rumination (bs = 3.72 to 9.97; Ps < .05). Follow-up analyses revealed that absorption was unrelated to ABP for those with high trait rumination but that more absorption predicted lower ABP for those less prone to rumination.

Conclusions

Our results suggest that regular engagement in absorbing SSAs is related to lower ABP. These findings have implications for the development of nonpharmacological interventions and suggest SSAs may serve as an adjuvant intervention strategy to lower BP.

Objective

Despite experimental manipulations that reliably elicit affective and physiological responses, the relationship between the two frequently appears small or nonexistent. We propose that this is, at least in part, due to a mismatch between the nature of the question being asked and the analytic methods applied. For example, to test if levels of affect reliably covary with physiology over time-a within-person question-one cannot apply analytic approaches that test whether people are similarly reactive across domains-a between-person question. The purpose of this paper is to compare within-person and between-person analyses testing the association between affect and physiology.

Method

Participants (N = 60) recalled an event from their lives that made them angry. Self-reported anger and objective blood pressure levels were recorded at baseline, after the recall, and 5 times during recovery.

Results

Between-person correlations between anger and blood pressure were nonsignificant across all phases of the study, suggesting that those least/most reactive for anger were not least/most reactive for blood pressure. These null findings held regardless of whether linear or nonlinear assumptions were modeled. In contrast, within-person multilevel modeling indicated a clear relationship, suggesting that when a person was angrier that person's blood pressure was higher compared with when that person was less angry.

Conclusion

Results suggest the importance of appropriately matching analytic strategy to the nature of the question regarding the relationships between affect and physiology. Implications for past and future research are discussed. (PsycINFO Database Record

Chronic stress has been linked to hypertension, but the underlying mechanisms remain poorly specified. We suggest that chronic stress poses a risk for hypertension through repeated occurrence of acute stressors (often stemming from the chronic stress context) that cause activation of stress-mediating physiological systems. Previous models have often focused on the magnitude of the acute physiological response as a risk factor; we attempt to extend this to address the issue of duration of exposure. Key to our model is the notion that these acute stressors can emerge not only in response to stressors present in the environment, but also to mental representations of those (or other) stressors. Consequently, although the experience of any given stressor may be brief, a stressor often results in a constellation of negative cognitions and emotions that form a mental representation of the stressor. Ruminating about this mental representation of the stressful event can cause autonomic activation similar to that observed in response to the original incident, and may occur and persist long after the event itself has ended. Thus, rumination helps explain how chronic stress causes repeated (acute) activation of one's stress-mediating physiological systems, the effects of which accumulate over time, resulting in hypertension risk.

Objective

Obtaining an accurate blood pressure (BP) reading is vital for diagnosing hypertension. However, BP measures taken in the physician's clinic (CBP) are subject to the 'white coat' bias. Measurements taken outside the office using ambulatory (ABP) and home (HBP) monitoring are superior predictors of cardiovascular diseases compared with CBP, but ABP remains underutilized because of the effort and expense involved. Unfortunately, HBP has limitations, including questionable device validity and patient compliance. Thus, it is important to identify feasible alternative techniques to measure BP in the office that will increase the accuracy of the diagnosis.

Methods

Auscultatory BP was measured in 249 patients in a nonclinical setting by trained technicians (NCBP); on the following day, patients were taken to their physician (CBP). They were also given an HBP monitor, and a 36 h ABP monitoring. Because ABP is considered the gold standard for prediction of cardiovascular disease, these readings were used as the criterion in a statistical model in which CBP, HBP, and NCBP were entered as predictors. The level of agreement between measurements was estimated.

Results

Multiple regression analysis showed that HBP and NCBP (P < 0.001) explained 94 and 87% of the variance in systolic and diastolic ABP, respectively. The agreement between NCBP and ABP was greater than that between CBP and ABP or between HBP.

Conclusion

When ABP monitoring and HBP monitoring are not options, the NCBP at the clinic can avoid the white coat bias and therefore improve diagnosis.