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ABSTRACT: OBJECTIVE:: The phenomenon of morning blood pressure (BP) surge (MBPS) is known to increase the risk for cardiovascular events and stroke. The purposes of this study were to explore associations between MBPS and nighttime BP and to examine arterial stiffness and sleep pattern in association with MBPS. METHODS:: This study included 30 healthy Korean American women aged 25 to 60 years. Ambulatory BP was monitored for 24 hours. To evaluate MBPS, maximum morning BPpower was calculated. Arterial stiffness was measured by carotid-femoral pulse wave velocity, and sleep pattern was evaluated using an actigraphy. RESULTS:: The participants (n = 8) in the upper quartile of MBPS had higher morning systolic BPs (SBPs; P = 0.015) and lower nighttime diastolic BPs (P = 0.031). The MBPS in SBP was significantly increased in the participants who had a more wakeful night (P = 0.038) and who slept longer at night (P = 0.041). Although MBPS was not significantly related to arterial stiffness, higher morning SBP (P = 0.005), morning diastolic BP (P = 0.048), and prewake SBP (P = 0.005) were associated with arterial stiffness. CONCLUSIONS:: Our findings imply a possible link between disturbed sleep and MBPS. Clinicians should understand the importance of the modification of altered sleep pattern for reducing MBPS in nonhypertensive participants.
The Journal of cardiovascular nursing 04/2013; · 1.43 Impact Factor
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ABSTRACT: Arterial stiffness is identified as a causative factor for hypertension. The purpose of this study was to explore the relationship between psychological stress and arterial stiffness in Korean Americans.
A convenience sample of 102 Korean Americans (aged 21-60 years, 60% women) was recruited from North Carolina. Psychological stress was measured by the Perceived Stress Scale, the Social, Attitudinal, Familiar, and Environmental (SAFE) Acculturative Stress Scale, and the Spielberger's State-Trait Anxiety Inventory. Arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor system (AtCor Medical, Australia).
This study shows that the emotional stress response, measured by anxiety, significantly predicted arterial stiffness (β=.25, p=.008), independently of such confounding factors as age, mean arterial pressure (MAP), gender, body mass index, smoking, education, and income. Anxiety was neither related to age (r=.12, p=.212) nor MAP (r=.14, p=.151). Additionally, this sample of Korean Americans had higher levels of psychological stress when compared to previous findings from studies of other racial/ethnic groups in the U.S.
Findings demonstrate that anxiety is a significant and independent determinant of arterial stiffness. Given that anxiety was not related to MAP, these findings suggest that arterial stiffness may be a pathway to explain the connection between anxiety and hypertension risk. Studies that scrutinize the relationship between anxiety and arterial stiffness are an important next step for future research. Further studies are also recommended to explore cultural factors and individual characteristics that may affect anxiety in Korean Americans.
Journal of psychosomatic research 07/2012; 73(1):53-8. · 2.91 Impact Factor
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ABSTRACT: Black American women have among the highest hypertension (HTN) rates in the world. Research suggests that nighttime might be a critical period of vulnerability for the development of HTN in Blacks. In the present study, personal factors (age, body fat, income, family history), psychological factors (stress, emotions, and John Henryism), and physiological factors (salivary cortisol and blood pressure [BP]) were explored in 30 Black women, ages 26-51 years. Data were collected in participants' homes. BP was monitored while participants were awake and asleep. Cortisol samples were obtained within the first hour after awakening. The usual pattern for BP is a drop or dipping of 10-20% during sleep; however, the BP for about a third of the subjects did not dip adequately during sleep. Though not statistically significant, this nondipping was clinically relevant and was associated with positive family history of HTN, more stress, lower positive and higher negative affect scores, and higher early morning cortisol levels. These findings add to the HTN risk profile and support the need to further explore the relationship between nondipping nighttime BP and cardiovascular disease in Black women.
Biological Research for Nursing 04/2012; · 1.28 Impact Factor
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ABSTRACT: The aim of this discursive paper is to introduce allostasis and allostatic load, which are relatively new concepts proposed to explain physiological responses to stress, and to suggest ways in which allostasis theory can be applied to the development of clinical interventions to increase resilience for producing better health outcome.
Common explanations of stress have failed adequately to explicate its association with health and chronic illness. Allostasis is the extension of the concept of homeostasis and represents the adaptation process of the complex physiological system to physical, psychosocial and environmental challenges or stress. Allostatic load is the long-term result of failed adaptation or allostasis, resulting in pathology and chronic illness.
The concepts of allostasis and allostatic load introduced the idea that external challenges initiate allostasis and chronic stress causes allostatic load that can be measured with multiple biomarkers. Finding from several studies suggests that higher allostatic load is associated with worse health outcomes. Resilience represents successful allostasis and strategies can be implemented to enhance resilience and thereby improve health outcomes.
This theoretical model provides a comprehensive explanation of the human body's adaptation processes in response to stress and the results of failed adaptation over time. In addition, combining the concepts of allostasis and resilience may help us to understand and implement clinical strategies better to reduce or prevent the debilitating physiological and psychological effects of chronic stress and chronic illness.
Clinical practice should be based on a solid theoretical foundation to improve health outcomes. Strategies to manage stress and increase resilience along with clinical interventions to manage the physiological responses to chronic stress are necessary to assist in preventing and controlling the detrimental effects of chronic disease on human life.
Journal of Clinical Nursing 05/2008; 17(7B):201-8. · 1.12 Impact Factor
