An historical and critical review of the articles on blood pressure published in Psychosomatic Medicine between 1939 and 1997

Between 1939 and 1997, there have been 59 volumes of Psychosomatic Medicine. Over this period there were 200 articles dealing with blood pressure. About 90% of these were concerned with high blood pressure. This article reviews all of these papers both from an historical perspective and critically. Although there has been a significant growth in the rate of articles published since 1939, there has always been a strong interest in the nature of hypertension particularly the roles of affects and emotions in the natural history of the disease. For example, volume 1, number 1 of the Journal includes a symposium on high blood pressure in which Franz Alexander stated his well-known hypothesis that the chronic inhibition of rage plays a causal role in the production of hypertension. In various forms, the notion that anger is an important mediator of hypertension has neither been proved nor abandoned. One major conclusion drawn from this review is that the current research on high blood pressure is drifting somewhat aimlessly. It has become preoccupied with demonstrations that various stimuli or situations (usually characterized as stresses) can acutely raise blood pressure. Despite this focus, neither the necessary nor the sufficient conditions for labeling a stimulus as stress has ever been agreed upon. Likewise, there have been many demonstrations of an iatrogenic effect on blood pressure, but neither the behavioral mechanisms underlying this effect nor the strategies for eliminating it have been explicated. Finally, this article identifies several areas where it would be useful to review and integrate current knowledge. Hopefully, such integrations could play a significant role in focusing and shaping future research and clinical practice.