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?|| |
|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|
|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|