From Brain to Behavior: Hypertension's Modulation of Cognition and Affect

Table 1

Diagrammatic illustration of integrated study of the natural history of hypertension.

Stage of Disease	Physiology	Affective	Cognitive
Normotensive/youth (genetic/familial risk)	All normal possible hyper-reactivity to lab stress, Mild elevation in SBP Opioid dysregulation	Anger? Reduced pain sensitivity	Subtle spatial attention, short term memory deficit
Borderline/Pre-hypertensive	BP >119/79 <140/90 with predominance of elevated DBP, sympathetic activation High cardiac output Baroreceptor adjustment; hyper reactivity to lab stress	Interpersonal difficulty Pain insensitivity Less awareness negative affect, positive affect?
Early Hypertension; (40–60yrs)	BP >140/90 High TPR Salt/diet sensitive Renin/angiotensin Aldosterone Sympathetic Structural/function brain changes Hyperreactivity	Above with transition to greater negative affect with inhibition of the expression of intense angry cognitive and emotive reactions	Mild deficits executive attention, working memory
Late Hypertension; (60+ yrs)	Same BP or isolated systolic hypertension? maintenance of altered regulatory system	Continued high negative affect and expression of negative affect?; awareness of BP status may invert relationship	Deficits not as clear relative to age matched; Related to Alzheimer’s Disease