Valutazione psicofisiologica della reattività emozionale nell'ipertensione arteriosa essenziale

Essential Hypertension is a pathology with high prevalence in developed society. It has a multi factorial etiology, comprising genetic, environmental and psychological factors. In recent years research focused on the role played by emotional factors in determining cardiovascular hyperreactivity, which in turn seems to play an important role in hypertension pathogenesis. Aim of these studies was to investigate differences in emotional reactivity between initial stage hypertensives and normotensives, by means of active and passive emotional tasks. Results confirmed previous data, finding an enhanced cardiovascular reactivity in hypertensives, specifically ß-adrenergic, compared to normotensives, in response to active tasks involving a psychosocial component (Speech test). Moreover, hypertensives showed an enhanced cardiovascular reactivity in response to psychosocial tasks with a negative emotional connotation compared with a neutral connotation. In particular, among activation indexes, heart rate was able to discriminate between different negative emotions. In response to a passive task (emotional picture viewing), a different activation pattern was highlighted in response to different emotional connotations of the stimuli, showing an alteration of pressor response affective modulation in hypertensives. This alteration did not seem to be located at subcortical level, as startle reflex affective modulation did not differ between hypertensives and normotensives. Subcortical circuits involved in affective modulation of the startle reflex seemed to be affected not by baseline blood pressure levels, but by cardiovascular reactivity elicited by emotional stimuli. In particular, results showed a lack in startle potentiation during unpleasant picture viewing in subjects who showed higher systolic blood pressure reactivity in response to both pleasant and unpleasant picture viewing. In conclusion, data support the hypothesis of a possibile role played by enhanced emotional reactivity in etiology and maintenance of essential hypertension.