The under-reporting tendency of hypertensives: An analysis of potential psychological and physiological mechanisms

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Abstract
Hypertensives have repeatedly been found to exhibit diminished self-report rates of stressor exposure and distress. In this article we discuss the evidence for two possible explanations for this phenomenon by means of reviews of the literatures on blood pressure in relation to defensive coping and pain perception. This approach provides support for the plausibility of two, not mutually exclusive, explanations: one based upon defensive coping and the other in terms of a physiologically based altered appraisal of aversive stimuli involving baroreceptor activity. Moreover, some indirect evidence has been obtained for a possible association between the two mechanisms. These findings have resulted in the formulation of a hypothetical model in which baroreceptor mediated central nervous system inhibition results in less negative appraisal of stressful situations and contributes to the development of hypertension via an operant conditioning mechanism. In addition, this mechanism may underlie the so-called defensive coping style. Finally, some directions for future research, aiming at testing the proposed model, are offered.