Pychosocial Factors and Cardiovascular Disease. A number of related psychosocial factors appear to confer risk for the development of hypertension and coronary heart disease. Examples include hostility, low social support, anxiety, and depression. Psychological distress is also implicated in cardiac patients’ prognosis. For example, accumulating evidence strongly suggests that anxiety and depression confer an increased risk of death following heart attack. Research in this area has progressed to the point that clinical treatment of depression following heart attack has been advocated to reduce the risk of mortality. Unfortunately, in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial, cognitive-behavioral therapy for depression did not reduce risk of death. The results of ENRICHD and other clinical trials (e.g., SADHART) have prompted researchers in this area to redouble efforts to identify mechanisms that explain the association of depression with cardiovascular risk. Research in the Cardiovascular Psychophysiology Laboratory focuses on depression, but we have also investigated cardiovascular correlates of hostility, interpersonal dominance, anxiety, posttraumatic stress, and low social support. Much of this research is conducted at Summa Healthy System in Akron, OH where we collaborate with investigators from the Cardiovascular Health and Rehabilitation Research Institute and the Center for the Treatment and Study of Traumatic Stress. For example, we are examining the predictors of depression and anxiety among heart failure patients treated with an implantable cardiac defibrillator. We are also examining the relationship between depression and the autonomic nervous system in patients enrolled in Cardiac Rehabilitation. We are evaluating the possible effect of depression on treatment gains during participation in Cardiac Rehabilitation. We are also investigating the functioning of the autonomic nervous system among individuals with posttraumatic stress disorder. The ultimate goal of this line of research is to improve efforts to prevent and treat cardiovascular diseases.

Hemodynamic Regulation of Blood Pressure. Exaggerated blood pressure (BP) and heart rate changes during stress are thought to contribute to the development of hypertension and heart disease. This idea has been called the “cardiovascular reactivity” hypothesis, and research involving cardiovascular changes during stress has attempted to explain cardiovascular risk associated with certain individual differences such as African American ethnicity and family history of hypertension. Over the last 20 years it has become apparent that characterizing the hemodynamic regulation of blood pressure helps to understand mechanisms of risk. For example, it is well established that hypertension is more prevalent in Black Americans than White Americans, and a variety of biological, environmental, psychological and social factors have been proposed to account for this ethnic difference. Findings for ethnic differences in BP reactivity during stress have been mixed, but studies that have examined the hemodynamic patterns underlying the BP response have been more informative. These studies have typically incorporated impedance cardiography to monitor cardiac output responses during behavioral stress, and have documented underlying changes in both cardiac output and systemic vascular resistance. One well established finding is that African Americans, compared with Whites, typically demonstrate BP increases during stress that are accompanied by a greater systemic vascular resistance contribution. We have been working to extend this research by evaluating whether ethnic differences in blood pressure regulation are also evident during everyday life, assessed using ambulatory hemodynamic monitoring. The goal of this line of research is to generate knowledge that leads to the development of more effective strategies for preventing and treating hypertension, in order to reduce ethnic disparities in cardiovascular health.