Anxiety, Anger, and Neurogenic Tone At Rest and in Stress in Patients with Primary Hypertension

SUMMARY To determine whether basal blood pressure or pressor responses to stress are related to sym-pathetic nerve tone or to psychological factors in hypertensives, 15 hypertensives and 13 normotensives were studied by means of a self-administered questionnaire, Isometric handgrip exercise (IHE), and the mental stress of serial subtraction. Plasma norepinephrine (NE), epinephrine (E), blood pressure (BP) and heart rate (HR) were measured before and at the end of IHE and mental stress. A greater number of hypertensives had suppressed anger (p < 0.01) and scored higher on anxiety trait (p < 0.01) and depression (p < 0.05). Prestress (IHE and mental) BP and NE values were significantly greater in hypertensives (allp < 0.01). Dur-ing IHE, both groups had a significant increase of BP, HR, and NE (allp < 0.01) but E rose in hypertensives only (p < 0.05). The percentage change of BP, HR, NE, and E during IHE was similar in both groups. The changes of BP and HR were not related to NE or E. During mental stress, HR (p < 0.01) and E (p < 0.05) in-creased in both groups. However, BP (systolic and diastolic) increased in nonnotensives only (p < 0.01). Plasma NE contents were unchanged In both groups. There were significant positive correlations of anxiety trait with systolic BP (p < 0.05), diastolic BP (p < 0.05), and NE (p < 0.05) and E (p < 0.05). Although hypertensives had increased neurogenic tone related perhaps to inward anger and anxiety, the percentage responses of neurogenic tone and BP to IHE were equivalent to those of normotensives. The challenge of seria