An historical context for behavioral models of hypertension

Objective: The pul pose of this study is provide an historical context for current behavioral models of hypertension. Methods: A selective sample of t he cardiovascular reactivity literature was reviewed, from 1932 to present. Results: In the earliest model, cardiovascular reactivity was regarded as a marker of disease risk; however, in later models, reactivity came to be v iewed as a causal influence in the development of hypertension. As the mode ls evolved, the underlying assumptions changed. Thus, the risk marker model assumed that cardiovascular responses to stress were a stable, generalized characteristic of the individual, and therefore the eliciting stimuli were arbitrary. The later models, however, assume that the nature of the elicit ing stimulus is a determinant of the cardiovascular response, We describe t he increasing complexity of the four models, and contrast their underlying assumptions and the implications of these assumptions. Conclusion: We provi de an overview of study designs and variables that should be incorporated i nto studies seeking to understand the ways in which cardiovascular response s to stress may influence the development of hypertension. (C) 2000 Elsevie r Science Inc. All rights reserved.