An historical context for behavioral models of hypertension

Abstract

Objective: The purpose of this study is provide an historical context for current behavioral models of hypertension.

Methods: A selective sample of the cardiovascular reactivity literature was reviewed, from 1932 to present.

Results: In the earliest model, cardiovascular reactivity was regarded as a marker of disease risk; however, in later models, reactivity came to be viewed as a causal influence in the development of hypertension. As the models evolved, the underlying assumptions changed. Thus, the risk marker model assumed that cardiovascular responses to stress were a stable, generalized characteristic of the individual, and therefore the eliciting stimuli were arbitrary. The later models, however, assume that the nature of the eliciting stimulus is a determinant of the cardiovascular response. We describe the increasing complexity of the four models, and contrast their underlying assumptions and the implications of these assumptions.

Conclusion: We provide an overview of study designs and variables that should be incorporated into studies seeking to understand the ways in which cardiovascular responses to stress may influence the development of hypertension.