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.People with Raynaud s disease lose circulation to peripheral parts of theirbodies such as their fingers and toes, suffering some pain and continual sensations ofcold in their hands and feet.The cardiovascular problems receiving the most attentionthese days are hypertension and coronary heart disease, and we look at both.First,let s consider the case of John.JohnThe Human VolcanoDurand 7-31John is a 55-year-old business executive, married, with two teenage children.Formost of his adult life, John has smoked about a pack of cigarettes each day.Although he maintains a busy and active schedule, John is mildly obese, partly fromregular meals with business partners and colleagues.He has been taking severalmedications for high blood pressure since age 42.John s doctor has warned himrepeatedly to cut down on his smoking and to exercise more frequently, especiallybecause John s father died of a heart attack.Although John has episodes of chestpain, he continues his busy and stressful lifestyle.It is difficult for John to slowdown, because his business has been doing extremely well during the past 10 years.Moreover, John believes that life is too short, that there is no time to slow down.He sees relatively little of his family and works late most evenings.Even when he sat home, John typically works into the night.It is difficult for him to relax; he feelsa constant urgency to get as many things done as possible and prefers to work onseveral tasks simultaneously.For instance, John often proofreads a document,engages in a phone conversation, and eats lunch all at the same time.He attributesmuch of the success of his business to his working style.Despite his success, John isnot well liked by his peers.His co-workers and employees often find him to beoverbearing, easily frustrated, and, at times, even hostile.His subordinates inparticular claim he is overly impatient and critical of their performance.Do you think John has a problem? Most people would recognize that hisbehaviors and attitudes make his life unpleasant and possibly lethal.Some of thesebehaviors and attitudes appear to operate directly on the cardiovascular system andmay result in hypertension and coronary heart disease.HypertensionDurand 7-32Hypertension (high blood pressure) is a major risk factor not only for stroke andheart disease but also for kidney disease.This makes hypertension an extremelyserious medical condition.Blood pressure increases when the blood vessels leading toorgans and peripheral areas constrict (become narrower), forcing more and moreblood to muscles in central parts of the body.Because so many blood vessels haveconstricted, the heart muscles must work much harder to force the blood to all parts ofthe body, which causes the increased pressure.These factors produce wear and tear onthe ever-shrinking blood vessels and lead to cardiovascular disease.A smallpercentage of cases of hypertension can be traced to specific physical abnormalitiessuch as kidney disease or tumors on the adrenal glands (Papillo & Shapiro, 1990), butthe overwhelming majority have no specific verifiable physical cause and areconsidered essential hypertension.Blood pressure is defined as high by the WorldHealth Organization if it exceeds 160 over 95 (Papillo & Shapiro, 1990), althoughmeasures of 140/90 or higher are cause for concern and more usually used to definehypertension (Wolf-Maier et al., 2003).The first value is called the systolic bloodpressure, the pressure when the heart is pumping blood.The second value is thediastolic blood pressure, the pressure between beats when the heart is at rest.Elevations in diastolic pressure seem to be more worrisome in terms of risk ofdisease.According to the latest comprehensive survey, 26.7% of individuals between age35 and age 64 suffer from hypertension in North America, with a corresponding andshocking figure of 44.2% in six European countries.These data, along with thepercentage of people taking medication to control hypertension and body mass indexlevels (see Chapter 8) are presented in Table 7.1.These are extraordinary numberswhen you consider that hypertension, contributing to as many fatal diseases as it does,Durand 7-33has been called the  silent killer. These numbers are much higher than for any singlepsychological disorder [ Pobierz całość w formacie PDF ]