Journal of Psychosomatic Research 48 (2000) 369–377 Review An historical context for behavioral models of hypertension William Gerin a,b, *, Thomas G. Pickering b , Laura Glynn c , Nicholas Christenfeld d , Amy Schwartz b , Douglas Carroll e , Karina Davidson b a Office of Behavioral and Social Sciences Research, NIH, Bethesda, MD, USA b Hypertension Center/Starr Pavilion ST405, Cornell University Medical Center/The New York Hospital, 525 East 68th Street, New York, NY 10021, USA c University of California Irvine, Irvine, CA, USA d University of California San Diego, La Jolla, CA, USA e University of Birmingham, Birmingham, UK f University of Alabama, Tuscaloosa, AL, USA Abstract Objective: The purpose of this study is provide an historical arbitrary. The later models, however, assume that the nature context for current behavioral models of hypertension. Meth- of the eliciting stimulus is a determinant of the cardiovascular ods: A selective sample of the cardiovascular reactivity litera- response. We describe the increasing complexity of the four ture was reviewed, from 1932 to present. Results: In the earli- models, and contrast their underlying assumptions and the est model, cardiovascular reactivity was regarded as a marker implications of these assumptions. Conclusion: We provide of disease risk; however, in later models, reactivity came to an overview of study designs and variables that should be be viewed as a causal influence in the development of hyper- incorporated into studies seeking to understand the ways in tension. As the models evolved, the underlying assumptions which cardiovascular responses to stress may influence the changed. Thus, the risk marker model assumed that cardiovas- development of hypertension.  2000 Elsevier Science Inc. cular responses to stress were a stable, generalized characteris- All rights reserved. tic of the individual, and therefore the eliciting stimuli were Keywords: Cardiovascular reactivity; Blood pressure; Heart rate; Hypertension; Individual differences Overview ated cardiovascular responses play a causal role in the development of hypertension [4]. One assumption com- Stress and other behavioral factors such as social mon to both viewpoints is that reactivity is a property support have been linked to a broad range of cardiovas- of the person (i.e., is unrelated to the circumstances in cular disease outcomes, including coronary heart disease which the reactivity occurs). [1,2] and hypertension [1,3]. The mechanisms, or path- More recent research, however, has focused on the ways, through which these influences operate, however, interplay of person properties and situation properties remain controversial. We will discuss the evolution and to understand the causal role that reactivity may play characteristics of four different psychophysiological re- in hypertension development [1]. Concern lies with what activity models that focus on the relationship between properties—either of persons or of situations—are stress and the development of hypertension. In the earli- pathogenic, and how they influence each other. For ex- est model, it was hypothesized that stressful events pro- ample, a situation may have a large effect on blood duce an increase in cardiovascular parameters such as pressure reactivity only if the individual possesses cer- blood pressure and heart rate, and that persons who tain trait characteristics. Thus, an irritating interper- display very large increases are at increased risk for sonal stressor may have more pronounced effects on a the development of hypertension. Thus, reactivity is a highly hostile person than on one who scores relatively property of persons that marks vulnerability to hyper- low on this dimension. In this model, reactivity contin- tension. A later model hypothesized that these exagger- ues to be linked causally to hypertension onset, but the link depends on the complex interactions between trait * Corresponding author. E-mail address: bgerin@ibm.net (W. Gerin) and situation characteristics. 0022-3999/00/$ – see front matter  2000 Elsevier Science Inc. All rights reserved. PII:S0022-3999(99)00095-1