Page 50 - JCBP-3-4

Journal of Clinical and
Basic Psychosomatics Emotion and blood pressure variability

While CVD risk is increased by factors that are difficult Physiologically, affective processing and BP regulation
to modify (e.g., age, gender, and family history of CVD), share a common set of brain regions. A wide range of
there is a spectrum of modifiable risk factors that may neural structures, including the amygdala, hypothalamus,
provide avenues to the prevention of CVD and promotion prefrontal cortex, insular, and cingulate cortex, are
6-8
of cardiovascular health. Hypertension, or high blood involved in both the processing of emotional stimuli and
pressure (BP), is one such modifiable CVD risk factor. BP control. 25-28 The neural output from these cortical and
BP status is linked to health behavior, such as a balanced subcortical structures will further activate the ANS. The
29
diet, smoking cessation, controlled alcohol consumption, samples in the previous studies on BP and depression
and regular exercise. Constantly high BP exerts excessive typically consisted of middle-aged and older adults or
7,8
strain on blood vessels, damages the endothelium, reduces those with diagnosed diseases. However, individuals with
the elasticity of blood vasculature, and eventually induces clinical depression and hypertension often already exhibit
atherosclerosis. These pathological processes increase ANS abnormalities, such as over-excitation of the ANS
9,10
the risk of heart attacks, heart failure, and stroke. 11,12 sympathetic division and reduced parasympathetic control
High BP is associated not only with health behaviors of cardiovascular activity. 30,31 As a result, the implications
but also with psychological processes. Notably, affective of those studies for the prevention of hypertension are
disorders, including clinical depression, are known to limited. Therefore, the present study focused on preclinical
contribute to chronic high BP. Depression is characterized young adults to investigate the association between affective
13
by altered affective processes. Individuals with ongoing processes and BP status before pathological changes occur.
depressive episodes or a history of depression show blunted A potential difficulty in the study of preclinical
emotional reactivity and reduced adaptive emotion populations is the selection of appropriate BP measures.
14
regulation (ER). Specifically, depressed people tend to Given that the average BP of at-risk but preclinical
be less sensitive to rewards and lose motivation to engage individuals may not meet diagnostic criteria, more sensitive
with positive stimuli. 15,16 On the other hand, increased measures other than average systolic and diastolic BP (SBP
negative bias is implicated in depression: individuals with and DBP) are needed. One such method is to assess BP
depression display exaggerated responses to punishment variability (BPV). BPV refers to fluctuations in BP over
and exhibit context-inappropriate emotional reactions. 17,18 specific periods, ranging from beat-to-beat BP changes to
In addition to affective reactivity, cognitive control of variations over weeks or months. Among different types
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emotional responses, that is, ER, also differs between of BPV, short-term BPV reflects BP variations occurring
healthy individuals and those with depression. Frequent over seconds to hours, usually within 24 h. It is primarily
use of maladaptive ER strategies, such as rumination, influenced by ANS activity and thus reflects psychological
expressive suppression, and avoidance, predicts the factors and stress responses. 33,34 The specific short-term
presence of depression or a higher risk for depression. BPV metrics include range, standard deviation (SD), mean
14
Furthermore, compared to healthy controls, adults with real variability, and coefficient of variation. Importantly,
35
current or past depression are less likely to use cognitive elevated BPV is independent of average BP to predict the
reappraisal, an adaptive ER strategy aimed to downregulate risk of CVD. 36-38 Therefore, BPV, especially its short-term
negative affect. 19 metrics, may reveal early impairment in BP control among
These affective dysfunctions are linked to chronic stress individuals with atypical emotionality before their adverse
and negative affect, which, in turn, activate the sympathetic cardiovascular outcomes meet diagnostic criteria.
division of the autonomic nervous system (ANS) and To address the research gap, the present study
the hypothalamic-pituitary-adrenal axis, leading to investigated whether affective reactivity and ER are
increased levels of inflammatory markers. 20-22 These ANS associated with short-term BPV in a preclinical population.
and endocrine responses collectively contribute to the BP was assessed using a standardized upper-arm-cuff
development of hypertension. In addition, the association protocol. This method, as opposed to 24-h continuous
between affective processes and high BP is bidirectional. BP monitoring, was selected for its feasibility and ease
The life stressors and physical limitations that are linked to of replication in typical clinical settings. A computerized
diagnosed hypertension can increase levels of depressive affective perception task was used to evaluate the accuracy
symptoms and perceived stress. 23,24 Taken together, of affective responses and trait differences in the use
although the relationship between hypertension and of ER strategies: Expressive suppression and cognitive
atypical emotionality is well documented, the mechanisms reappraisal. This investigation on affective processes
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of the relationship remain unclear. and BPV among young adults may shed light on early

Volume 3 Issue 4 (2025) 44 doi: 10.36922/jcbp.8134