Psychological aspects of hypertension. I. The influence of experimental interview variables on blood pressure.

Many investigators have demonstrated that human blood pressure can be made to rise under the influence of various noxious or psychologically stressful stimuli. The role played by responses to such stimuli in the etiology of essential hypertension has been the subject of much intense speculation and research, most recently reviewed by S. Wolf, et al.' and Geiger and Scotch.2 A major problem in interpreting the results of such investigations has been the influence of the research situation itself. Stewart Wolf, et al., using stress interviews tapping known areas of conflict in hypertensive subjects, induced significant BP increases.' The stimulus of a projective psychological test, namely the Thematic Apperception Test (TAT), has been found to produce BP rises, described by Weiner as dependent more upon the establishment of an "emotionally meaningful interaction" between the subject and the examiner than upon the content of the communication by the subject.3 Varied stresses, such as thermal pain, rapid discrimination and mirror drawing have been associated with blood pressure rises.' The nature of the subject's reaction to general aspects of the testing situation probably affects the degree of his physiological response to specific experimental stimuli. Reiser felt that the subject's expectations and the laboratory and the experimenter may in themselves play a significant role in affecting the physiological parameters, such as blood pressure , but they did not define these situational factors any further.! Other authors have attempted to characterize these nonspecific factors causing increases in blood pressure. Shapiro has suggested the presence of a non-specific "task stress" contributing to blood pressure rises in hypertensives in test situations involving TAT cards.6 Similarly, Weiner noted the * Third year medical student.