Psychological Factors Affecting Ambulatory Blood Pressure in a High-Stress Occupation

Abstract

Since the first recording of indirect and direct ambulatory blood pressure (BP) in human subjects (Bevan, Honour, & Stott, 1969; Hinman, Engel, & Bickford, 1962), the advantages of recording BP in natural settings have become firmly established. Compared to BP values obtained in a doctor's office or clinic, 24-hr ambulatory BP measurements are less likely to give inflated estimates of an individual's BP (Burstyn, O'Donovan, & Charlton, 1981; Floras, Jones, Hassan, Osikowska, Sever, & Sleight, 1981; Mancia, 1990); they also offer a more precise means of evaluating the efficacy of antihypertensive medications (Des Combes, Porchet, Waeber, & Brunner, 1984; Rion, Waeber, Graf, Jaussi, Porchet, & Brunner, 1985) and provide a better predictor of the development of cardiovascular morbidity and mortality (Cheung & Weber, 1988; Harshfield, Pickering, Kleinert, Blank, & Laragh, 1982; Pessina, Palatini, Di Marco, Mormino, Fazio, Libardoni, Mos, Casiglia, & Dal, 1986). These advantages derive from the fact that the 50–100 readings typically obtained in a single 24-hr ambulatory recording yield a considerably more stable mean level of BP compared to the two or three readings obtained in an office examination. The multiple readings also offer a good means of estimating BP variability in the individual, another significant correlate of target-organ damage (Parati, Pomidossi, Albini, Malaspina, & Manda, 1987).