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Elevated Resting Blood Pressure and Dampened Emotional Response

From the Department of Psychology, Clemson University, Clemson, SC.

Address correspondence and reprint requests to Cynthia Pury, Department of Psychology, Clemson University, 418 Brackett Hall, Clemson, SC 29634-1355. E-mail: cpury{at}clemson.edu

	ABSTRACT

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OBJECTIVE: Increased blood pressure is associated with decreased reports of aversiveness for both physical pain and psychosocial stressors. Based on these findings, higher blood pressure could be associated with altered emotional responses to a broader range of stimuli. There are at least 3 ways this could happen: a) less dire response to negative stimuli with no change in response to positive stimuli; b) more positive responses to both negative and positive stimuli; or c) dampened emotional responses to both positive and negative stimuli.

METHODS: Sixty-five normotensive volunteers had their resting blood pressure measured, then rated their emotional responses to a series of positive and negative photographs.

RESULTS: Resting systolic blood pressure was significantly and negatively correlated with subjective emotional ratings of both positive (r = –.26) and negative (r = –.35) photographs.

CONCLUSION: Results were consistent with emotion dampening for elevated resting blood pressure and may reflect homeostatic integration of neurocirculatory control and affect regulation.

Key Words: resting blood pressure, • emotion, • affect, • elevated blood pressure, • emotional dampening, • IAPS.

Abbreviations: SBP = systolic blood pressure;; DBP = diastolic blood pressure;; HR = heart rate;; IAPS = International Affective Picture System;; PANAS = Positive and Negative Affect Scale;; PA = positive affect;; NA = negative affect;; STAI = State-Trait Anxiety Inventory;; PCL-C = PTSD Checklist-Civilian.

	INTRODUCTION

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The influence of blood pressure on pain sensitivity has been known for the past 20 years (1,2). The diminished pain sensitivity of hypertensive animals and humans has been widely replicated, but is nevertheless poorly understood. Recent work (3,4) shows that a linear relationship between resting blood pressure levels and pain sensitivity extends into the normotensive range. This suggests that the relationship between blood pressure and pain sensitivity is not simply a pathophysiological consequence of clinical hypertension, but may be part of a more basic mechanism, perhaps linking visceral neurocirculatory afferent function to pain experience (5).

This relationship may represent blood pressure–induced changes in perceived aversiveness, rather than in pain sensation. For example, Fillingim et al. (6) suggested that the effect of elevated blood pressure on pain is a result of reduced affective response rather than reduced pain intensity. Moreover, there is evidence that this reduced aversiveness is not limited to painful stimuli. Nyklicek and colleagues (7–10) suggest that the level of blood pressure can reduce the aversiveness of psychosocial stressors and other nonpainful aversive stimuli. We propose that perhaps the effect may be even broader, with blood pressure influencing affective responses in general, rather than just negative responses.

Affective response is multifaceted. Reports from the emotion literature suggest at least two dimensions of emotional response: valence and arousal (11,12). Valence typically indicates a positive to negative state, whereas arousal indicates a high to low energy state. Although more extreme valences (both highly positive and highly negative) are usually associated with increased arousal, this is not always the case (11,13). For example, sadness can be characterized as a state of very negative valence and low arousal, whereas tranquility can be characterized as a state of very positive valence and low arousal.

A rotation of these two factors leads to the dimensions of positive affect (PA; strongly positive valence with high arousal) and negative affect (NA; strongly negative valence with high arousal). Although PA and NA frequently show an inverse relationship, they can be considered as orthogonal dimensions (14). One popular model of anxiety and depression (15) suggests that both anxiety and depression are characterized by abnormally high levels of negative affect, but that depression has an added component of abnormally low positive affect. Additionally, predictors of high NA may not act as effective predictors of low PA (16).

Thus, any model of blood pressure and affect should view affective response as more complex than just a simple unidimensional construct ranging from positive to negative. This complexity leads to at least three different predictive models of the effects of blood pressure on emotional response. The ameliorative model suggests that increased blood pressure leads to less dire appraisal of negative stimuli, with no effect on appraisal of positive stimuli. The positivity bias model suggests that increased blood pressure is associated with a more positive appraisal of stimuli. Thus, negative stimuli seem less negative and positive stimuli seem more positive. Finally, the emotion dampening model suggests that overall emotional responding may be reduced for those with higher resting blood pressure. Thus, negative stimuli seem less negative and positive stimuli seem less positive. To compare these models, we measured resting blood pressure in a group of normotensive participants, then asked them to rate their response to a series of emotionally provocative photographs. Ratings were made for both valence and arousal, and correlated with resting blood pressure.

	METHODS

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Participants
Young adult participants were recruited from an ongoing blood pressure screening. Sixty-five individuals (48 women, 17 men) participated in the study. Thirty-nine participants described their ethnic background as white, 14 as African-American, 7 as Asian, 2 as Hispanic, and 2 as "other." One participant did not indicate ethnicity. Twenty-eight participants had a positive family history of hypertension. Mean body mass index was 22.9 (SD = 4.4) and mean age at time of screening was 19.8 years (SD = 2.3). There were no effects of gender, ethnicity, family history, or body mass index on the results reported below.

Materials and Apparatus
Photographs were selected from the International Affective Picture System (IAPS) (17). This set consists of 604 photographs that have been rated on valence, arousal, and dominance by participants from all over the world. Using Lang et al.’s data set, we compared gender differences for valence and arousal ratings. Of the 604 images, 384 had relatively small gender differences (within 1 point on a 9-point scale) for both valence and arousal ratings¹ and were retained for further consideration.

To select prototypical positive and negative photographs from this subset, separate regression equations predicting valence from arousal were computed for positive (mean valence rating > 5.0) and negative (mean valence rating < = 5.0) images. For positive photographs, the unstandardized equation was Estimated Valence = 4.71 + (0.42 * Arousal). For negative photographs, the unstandardized equation was Estimated Valence = 6.12 + (–0.55 * Arousal). Fifty-seven positive photographs and 57 negative photographs were found to have residuals smaller than 0.3 and were selected as most representative of the positive and negative sets. Photographs depicting mutilation, blood, or injury (six negative photographs) were removed due to the noted relationship between a strong negative response to such material and possible vasovagal effects (18,19). Photographs depicting sexually provocative images (three positive photographs) were removed due to methodological concerns. The remaining photographs were rated by laboratory personnel for ambiguity and complexity. Sixteen positive and 16 negative photographs, matched on ambiguity and complexity, were chosen for use as stimuli in the present experiment. Each photograph was of relatively distinct content, and each set represented the entire regression line, from low arousal–neutral valence to high arousal–strong valence. Four additional photographs, relatively neutral in valence and low in arousal, were selected for practice trials.

Photographs were presented on a Gateway P5–133 computer running E-Prime software (20). The program also collected valence and arousal ratings made by participants.

Resting blood pressures and heart rate were measured by a Critakon Dinamap Pro 100 Vital Signs Monitor (Johnson and Johnson, Tampa, FL). This device provides repeated measures of systolic (SBP) and diastolic (DBP) blood pressure, as well as heart rate (HR), using oscillometric techniques. It has proven both valid and reliable in comparison with auscultatory techniques (21).

Procedure
Picture Rating Session
Immediately on arrival in the laboratory, the participant was seated in front of the computer in a comfortable chair with armrests. The participant provided informed consent, and approximately 5 minutes later brachial blood pressure and HR readings were taken from the nondominant arm every 2 minutes for a total of 10 minutes. Resting blood pressures and HR were computed as the mean of all five readings. Blood pressures were not taken during the photograph rating task due to concerns that the distraction caused by cuff inflation would influence participants’ ratings of their emotional response.

Directly after the blood pressure determinations, the computerized picture rating task began with written instructions modified from the original IAPS rating instructions (13) and presented on the computer screen. Participants were asked to rate the valence and arousal they experienced while viewing each picture. The valence scale was a 9-item rating scale with anchors of completely UNHAPPY (1) and completely HAPPY (9), and the following instructions "At one extreme, a rating of 9 indicates that you felt completely happy, pleased, satisfied, contented, hopeful. At the other extreme, a rating of 1 indicates that you felt completely unhappy, annoyed, unsatisfied, melancholic, despaired, bored." The arousal scale was a parallel 9-item rating scale with anchors of completely CALM (1) and completely EXCITED (9), and the following instructions "At one extreme, a rating of 9 indicates that you felt completely stimulated, excited, frenzied, jittery, wide-awake, aroused. At the other extreme, a rating of 1 indicates that you felt completely relaxed, calm, sluggish, dull, sleepy, unaroused."

For each trial, participants heard a tone accompanying a 1-second written warning ("Get ready"). A second tone signaled the onset of the photograph, which was presented for 6 seconds. After each photograph, the participant first rated the valence, then the arousal level of his or her emotional response. After a 10-second rest period, the next photograph was presented. There were 4 practice trials and 32 experimental trials. Experimental photographs were randomly ordered for each participant.

Additional Control Measures
A subset of our participants had completed a variety of affective trait questionnaires during a blood pressure screening conducted several days to several weeks before their participation. The Positive and Negative Affect Scale (PANAS (22); N = 64) was used as a measure of trait positive affect (PA) and negative affect (NA). The trait version of the State-Trait Anxiety Inventory (STAI (23); N = 61) was used as a measure of trait anxiety. Finally, the PTSD Checklist-Civilian (PCL-C (24); N = 64) was used as a measure of posttraumatic symptoms, as PTSD has been associated with both increased blood pressure and with emotional numbing.

Data Analysis
For ease of interpretation, valences for negative photographs were reverse scored, such that higher numbers represented a more intense emotional response.

General linear models with two within-participants factors (type of photograph: positive or negative, and type of rating: valence or arousal) were used to test the effect of the resting blood pressures on emotional response ratings. If the ameliorative hypothesis is correct, there should be an interaction between type of photograph and blood pressure, with a negative correlation of blood pressure with ratings of negative photographs and no correlation with ratings of positive photographs. If the positivity hypothesis is correct, there should be an interaction between type of photograph and blood pressure, with higher blood pressures having a positive correlation with ratings of positive photographs and a negative correlation with ratings of negative photographs. If the emotion-dampening hypothesis is correct, there should be a main effect of blood pressure such that blood pressure has a negative correlation with ratings of both negative and positive photographs.

	RESULTS

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Descriptive statistics for cardiovascular measures, valence ratings, and arousal ratings are presented in Table 1. As can be seen, blood pressures were within normal limits for young adults.

DPB
There was a marginal main effect of DPB on all types of ratings for all types of photographs, F(1,63) = 2.63, p < .11, again consistent with the emotion-dampening hypothesis and such that higher DBP was marginally associated with more neutral ratings overall, r = –0.20. There was also a marginal main effect for type of rating, F(1,63) = 3.30, p < .08 (Table 1). However, there were no other main effects nor interactions; all remaining Fs < 1.3.

HR
There was a significant main effect of type of rating, F (1,63) = 5.28, p < .03, such that higher ratings were made for valence ratings than for arousal ratings (Table 1). There were no other main effects or interactions, all Fs < 1, including no effects or interactions for HR.

Additional Control Measures
To determine whether the relationship between SBP and dampened emotional response was due to differences in trait affect, the analysis was repeated 4 times with additional predictors: trait anxiety, PA, NA, and PTSD symptoms. The main effect of SBP remained significant in all 4 analyses, with Fs ranging from 8.95 to 10.27 (all p values < 0.01). Subsequent analyses showed that these main effects indicated a negative relationship between SBP and emotional ratings of both types of photographs (partial correlations of SBP with overall emotion ratings ranging from –0.23 to –0.39), suggesting that SPB is negatively associated with emotional response even when trait affect is taken into account.

	DISCUSSION

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The present study shows that the level of resting SBP predicts a significant proportion of the variance in emotional response to subsequent visual stimuli. This effect is one of emotion dampening, rather than an ameliorative effect or a positivity bias. These results suggest that prior research on the relationship between blood pressure and subjective ratings of negative stimuli (pain, psychosocial stress) may be reflecting a general tendency toward reduced responsiveness to emotionally provocative stimuli in general. Results from the present study were obtained from normotensive young adults; future research should address gender specificity and extend these findings to older, less healthy populations. Nevertheless, our results suggest a more basic dampening relationship between resting blood pressure and affective response. This blood pressure–related emotion reduction is similar for both positive and negative stimuli, and for both valence and arousal ratings.

In the present methodology, arousal ratings were made immediately after valence ratings. It is possible that valence ratings might have contaminated arousal ratings. However, emotional responding in complex naturalistic settings is not likely to be separated into valence and arousal, but rather to represent a more general pooled response.

The present study extends findings of blood pressure–related changes in emotional response. Increased blood pressure has been associated with decreased pain sensitivity in human hypertension and in various animal models of high blood pressure (1–3). This blood pressure–associated hypoalgesia appears to be a fundamental basic psychophysiologic mechanism, found in hypertensive animals and humans, as well as in both male and female normotensive volunteers (2–4). Moreover, this influence exerted by blood pressure is not confined to pain pathways, but rather may represent a more generalized influence on psychosocial and emotional responding. Therefore, in addition to reduced sensitivity to pain (4), individuals with elevated systolic blood pressure also show reduced appraisal of psychosocial stress (7), and, in the present study, dampened emotional response to both negative and positive pictures.

This dampened emotional response associated with increased blood pressure is especially interesting given the prominent excitatory role of visceral arousal in some classical theories of emotion. For example, both the James–Lange theory (25,26) and Schachter and Singer’s 2-component theory of emotion (27) suggest that increased visceral arousal will increase the emotional impact of a stimulus. This may be true on a very acute basis for concurrent visceral–emotional linkage. However, more chronic, ongoing levels of SBP appear to decrease the emotional impact of subsequent stimuli (28) and may be related to decreases in chronic states of PA and NA (29).

Although the details of this mechanism are as yet unknown, one of the more intriguing possibilities is that blood pressure influence on affective appraisal serves as a negative feedback mechanism that helps to limit our behavioral response to intense stimuli. For example, aversive stimuli have been consistently associated with acute increases in blood pressure. If increased blood pressure activates an inhibitory visceral afferent pathway, then our experience of the aversiveness of subsequent stressors will be dampened. Therefore, the stimulus for subsequent visceral arousal is reduced, thus facilitating normalization of behavioral and visceral functioning. This mechanism may have significant survival value to the degree that very high levels of arousal can degrade performance.

The current data are correlational and may not represent a causal pathway from blood pressure to dampened emotional response. One possibility is that individual differences in emotional responsiveness drive individual differences in resting blood pressure. There is a sizable classic literature indicating that more extreme emotional responses lead to acute increases in blood pressure. However, extending these findings to resting blood pressure should lead to positive correlations, not to the negative ones found here. Moreover, active baroreceptor stimulation increases some measures of pain threshold in humans (30). Thus, the present results, consistent with the work of Maixner and colleagues (31), suggest that pressure-sensitive visceral afferent pathways may produce a broad inhibitory effect on the processing of affective stimuli. The baroreceptors and their baroreflex pathways comprise a complex system with extensive input to the CNS (32). Although the present data on resting blood pressure might point to mechanisms of baroreceptor set point rather than baroreflex sensitivity, Nyklicek and co-workers suggest that these findings do not necessarily rule out baroreflex sensitivity. For example, Nyklicek et al. (33) point out that simultaneous and interactive effects of blood pressure and affect regulatory mechanisms could mask any underlying relationship between acute blood pressure reactivity and dampened emotional response.

Several investigators suggest that endogenous opioid mechanisms may be involved in links between blood pressure and pain sensitivity. For example, McCubbin and Bruehl (34) showed that opioid receptor blockade with naloxone partially disrupts the relationship between blood pressure and pain sensitivity. There is ample literature to suggest that the effects of both exogenous and endogenous opiates go beyond simple analgesic influences. Endogenous opioid pathways are abundant in both the peripheral and the central nervous systems, and several studies have emphasized their role in emotional experiences (35,36). Future research should examine this potential mediating factor.

Regardless of the precise neuroendocrine mechanism, the link between blood pressure and affect regulation may shed light on important circulatory disease phenomena. For example, one theory of essential hypertension suggests that the reinforcing aspects of pain alleviation could operantly condition blood pressure increases (10,37,38). These effects may be moderated by affective motivational mechanisms. Blood pressure reliably increases in response to both psychosocial stressors and to exciting positive stimuli. If those with higher resting blood pressure perceive their environment as less threatening, they may stay in stressful situations for longer. Likewise, they may also seek out greater levels of excitement. Both may lead to further increases in their cardiovascular activity as they engage in objectively more arousing activities.

Additionally, the observation of a significant and pervasive affective influence of blood pressure may help clarify several pathological processes. Several studies have found notable distortions in the relationship between blood pressure and pain report in pain patients (39,40). For example, in a study of pain patients, Bruehl et al. (39) observed that the negative correlations between blood pressure and pain progressively shifts over time to positive correlations in chronic pain patients.

The present study raises new issues in formulations of emotion regulation. Our results showed that increased blood pressure was associated with subsequent decreases in both positive and negative emotion, thus providing support for the emotion-dampening hypothesis rather than the ameliorative or positivity bias hypotheses. Much like the findings in pain patients (39), blood pressure–related affective dampening mechanisms might clarify pathological changes in some emotional disorders. For example, links between autonomic arousal, endogenous opioids, and blood pressure regulation in PTSD suggest that the integration of these systems may play a role in coping with traumatic stress (41,42). Interestingly, a prominent complaint of individuals with PTSD is emotional numbing (43), which may be mediated by opioids (41). Elevated rates of hypertension are frequently found in PTSD samples (44,45), and our current findings suggest that numbing symptoms might be most prevalent in patients who are comorbid for PTSD and hypertension.

Future studies of affective dampening mechanisms should focus on characterization of the integration of neurocirculatory processes and affect regulation. These mechanisms could provide important insight into the cause and treatment of diseases of circulation, pain sensitivity, and affect regulation.

	ACKNOWLEDGMENTS

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This research was supported in part by NIH grants RO1 HL32738 to James McCubbin and F32 HL10227 to Suzanne Helfer.

We thank Chantay Ivester and Michelle DiMaio for their help.

	NOTES

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¹For readers familiar with IAPS, this removed most of the images of infants and of sex.

Suzanne Helfer is now at Adrian College, Adrian, MI.

Received for publication January 4, 2003.

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pury, C. L. S. Articles by McMullen, L. J. Search for Related Content PubMed PubMed Citation Articles by Pury, C. L. S. Articles by McMullen, L. J.