Psychogenic Factors in Essential Hypertension

Publisher Website
Google Scholar
Abstract
Summary A combined psychoanalytic and physiological investigative technique is possible and useful in the design of a definitive psychophysiological experiment for the elucidation of psychogenic factors in essential hypertension. The Nickerson ballistocardiograph is a valid and consistent physiological technique for the determination of the stroke volume and cardiac output in early cases of hypertensive vascular disease. This hemodynamic value and the blood pressure can be used to calculate the total peripheral resistance. An attempt is being made to analyze the psychodynamic data in terms of the predominant affects of anxiety and rage in relationship to deprivation of basic needs. Hypertensive individuals tend to mobilize an excessive and continuous quantity of anxiety and rage in response to frustration of basic dependency and security-status needs. These affects are poorly suppressed, only partly repressed, minimally bound in specific psychic symptoms, and inadequately discharged through verbalization or motor activity. The three general psychodynamic and hemodynamic correlations are as follows: (a) Rage and resentment are the predominant psychic concomitants of excessive blood pressure elevations of 160-200/100-130 mm. and are related to an increased peripheral resistance with normal stroke volume and heart rate. (b) Anxiety with minimal overt expression is the predominant psychic concomitant of the minor blood pressure elevation of 140-160/ 90-100 mm. and is related to increased peripheral resistance with normal stroke volume and heart rate. (c) When the anxiety components were more overtly expressed the minor blood pressure elevations were related to increased stroke volume and heart rate and a normal peripheral resistance. Psychotherapeutic modification of the emotional problems of hypertensive individuals was possible. In these research cases major reconstructive personality changes have been achieved. The psychotherapeutic modification of the early hypertensive vascular process appears possible. To date, in the 4 transient cases, a 2-6-year remission of the vascular blood pressure lability has been obtained. In the 2 experimental cases with sustained hypertension, a 5-year remission appears probable in the first subject and possible in the second subject.