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From the Behavioral Medicine Program (R.P.S., E.B.), Columbia-Presbyterian Medical Center; Division of Clinical Psychobiology, Department of Psychiatry (R.P.S., P.A.S., J.M.F.), Division of Consultation/Liaison Psychiatry, Department of Psychiatry (P.A.S.), and Division of Biostatistics (E.B.), School of Public Health, Columbia University; and New York State Psychiatric Institute (R.P.S., M.M.M., J.M.G.), New York, New York.
Address reprint requests to: Richard P. Sloan, PhD, Columbia University, Box 427, 622 West 168th St., New York, NY 10032. E:mail: rps7{at}columbia.edu
This article presents a model that identifies effects of blood pressure variability (BPV) as a possible mechanism by which psychological/psychiatric factors and health behaviors confer increased risk of coronary artery disease (CAD) and acute coronary syndromes. Recent research in vascular biology and dynamics of coronary artery blood flow suggests that BPV may have pathogenic effects on the coronary endothelium, plaque formation, and plaque stability. Thus, BPV may be a risk factor for cardiovascular disease independent of mean arterial pressure. The model proposes that autonomic control of the heart exerts a buffering or inhibitory influence on oscillations in blood pressure. Established psychological/behavioral risk factors for CAD, such as depression, hostility, and anxiety, as well as physical deconditioning and aging, are associated with diminished autonomic control of the heart, which may disinhibit pathogenic BPV. Together, these data suggest a coherent, testable psychophysiological model of CAD. In this article, we review these data and make recommendations for research to examine the model.
Key Words: coronary artery disease, • psychological factors, • blood pressure variability, • heart rate variability.
Abbreviations: BPV = blood pressure variability;; CAD = coronary artery disease;; HR = heart rate;; HP = heart period;; BP = blood pressure;; HPV = heart period variability;; HF = high frequency;; MI = myocardial infarction;; LF = low frequency;; VLF = very low frequency;; MAP = mean arterial pressure;; CVP = central venous pressure;; LVM = left ventricular mass;; SBP = systolic blood pressure;; DBP = diastolic blood pressure;; PRA = plasma renin activity;; DBPV = diastolic blood pressure variability;; SBPV = systolic blood pressure variability;; 
BPV = change in BPV;; ANS = autonomic nervous system.
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