Stress Related Hypertension Research Proposal

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Stress and Hypertension

The Effect of Stress Reduction on Hypertension

Chronic hypertension is a key factor in the development of coronary artery disease and other life-threatening conditions including stroke, heart attacks, heart failure, aneurysm, and is a leading cause of renal failure (Guyton & Hall, 2005). Even slightly elevated blood pressure could lead to a shorter life (Guyton & Hall, 2005). When mean arterial pressures are elevated to 50% of more then the average population, the life expectancy of the person can only be expected to be a few years without treatment (Guyton & Hall, 2005). Learning to control hypertension is an important factor in improving the quality and quantity of their life.

Statement of the problem: Given the absence of physiological conditions that lead to hypertension, lifestyle changes are the most common recommendation made in relation to the reduction of hypertension. The connection between stress and hypertension has been a topic of interest for many years. However, the importance of stress in chronic hypertension has received mixed results. This study will address the problem of whether a clear connection exists between a person's daily stress level and chronic hypertension. It will ask the research question, "Do high average high daily stress levels have a correlation with chronic hypertension in adults?"

Literature citations and review:

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Chronic hypertension and its causes have received a considerable amount of academic attention. One of the key problems in this research is that the cause of hypertension in an individual may not be related to a single cause. For instance, a person may have a combination of factors that contribute to their hypertension, such as age, vitamin D deficiency, Cushing's disease, and obesity. A person may have several risk factors at the same time and it may be difficult to isolate a single factor in a research setting. The following literature focuses on the connection between stress and hypertension, using recent academic research.

Research Proposal on Stress Related Hypertension Assignment

Stress produces a chain reaction neurophysiologic response in the body that has many side effects on a number of systems. Recent research aggress that stress is not a primary cause of hypertension, but it does agree that stress exacerbates the development of hypertension in those that have additional risk factors (Larkin, 2005). The body is designed to produce temporary hypertension in response to an additional need for oxygen in an emergency situation. However, this reaction is only supposed to be for a short time (Larkin, 2005). In many cases, the exact cause of primary hypertension is unknown (Larkin, 2005). However, chronic levels of stress have a positive association with the development of hypertension (Larkin, 2005).

Hypertension has a positive association with increased vascular oxidative stress. However, the direction of causation is still a topic of debate (Grossman, 2008). According to this study, treatment with antioxidant supplements have failed to demonstrate any benefit (Grossman, 2008). Although antioxidants have demonstrated no control ability over hypertension, evidence suggesting the connection between oxidative stress and hypertension remains significant (Ward & Croft, 2006).

One study found that when rats were given the drug pioglitazone, and subjected to a diet designed to produce obesity, those that were given the drug did not develop hypertension associated with obesity (Dobrian, Shriver, Khraibi & Prewitt, 2004). Calcium antagonist treatment using Lercanidipine was found to prevent hyperpolarization in hypertension (Taddei, Virdis, & Ghiadoni, 2003). This effect may be the product of antioxidant activity (Tomlinson, Benzie, & Taddei, 2003).

The literature clearly indicates a connection between stress and hypertension. However, stress is not considered to be a primary cause of hypertension. Hypertension develops when other factors are present, with stress acting to exacerbate the reactions. Our bodies are geared to handle an acute burst of stress, as part of our built in survival mechanism. However, we are not designed to work under maintained chronic stress levels. Stress has many negative effects on the body. A growing body of evidence exists that research is getting closer to understanding how these mechanisms work more clearly.

The literature review revealed several keys that provide an excellent opportunity for investigation. Many of the studies found that claimed a direct relationship between hypertension and stress as a primary cause were older. Studies that are more recent indicate that although stress may be an important factor in the development of hypertension, it does not usually act alone, but in conjunction with other factors. A gap in the literature continues to exist between the correlation between stress and hypertension. Early studies were often found to be plagued with validity issues, such as the existence of confounding variables and the inability to account for them. This research will attempt to fill in the gap between chronic stress levels and hypertension in a population.

Statement of hypothesis: The purpose of this study is to conduct valid research that will support the connection of stress and hypertension. It will use the following hypotheses as guidance for conduct of the research.

H1: Women who have been diagnosed with hypertension will demonstrate significantly higher levels of stress than those that do not have hypertension.

H2: The level of stress in women diagnosed with hypertension will demonstrate a proportionate relationship with the severity of hypertension.

H3: Both hypertension and stress levels will be lower after participation in a 4-week stress reduction class.

In this study, the presence or absence of hypertension and the initial level of stress will serve as the independent variable. The reason for this choice is that these two factors cannot be controlled in the initial patient assessment. These factors will be used for primary classification of the patient into one of the study groups.

The level of stress and hypertension after treatment with the 4-week stress reduction class will serve as the dependent variable. In this case, the stress level reduction class will serve as the treatment that is applied to the patients. Its response to treatment will be used to determine if the conditions of the hypothesis are met. The control group will consist of women that have high levels of stress and hypertension, but that do nothing to reduce their levels of stress over the study period. This group of women will be compared to those that receive the treatment. This group is similar to the placebo group in a drug study.

II. Methods

Sample section:

Target Population - This study will use a group of 500 women between the ages of 35-50 years old. The women will be examined for the presence of hypertension and their stress levels measured at the beginning of the study period. This information will be used to categorize them into the following categories:

Hypertensive/high stress

Hypertensive/low stress

Nonhypertensive / high stress

Nonhypertensive/low stress

Sampling procedure specifications: Subjects will be obtained by recruiting volunteers from among patients under a doctor's care for hypertension. Consent forms and information will be distributed to physician's offices. Those that wish to participate can indicate as such on the form and return it to the receptionist, who will be familiar with the study protocol and will begin the procedure. The study will only be offered to women aged 35-50. It will be for women of any ethnic background.

In order to eliminate several confounding variables, the following conditions will lead to exclusion from the study: obesity, renal dysfunction, type I diabetes, cancer, coronary artery disease, previous stroke or heart attack, Cushing's disease, or any other condition that is the primary cause of their hypertension. The purpose of this sampling technique is to isolate a group of women for which hypertension and stress are the primary diagnoses.

Sample description: It is expected that participation in this study will entail extra time for filing out the survey. In addition, patients that are selected for the 4-week stress reduction program will have to invest 1 hour 2 times a week for 4 weeks. These time constraints may affect the ability to recruit a sufficient number of study participants. However, patients will benefit from the knowledge gained, and a potential reduction in their hypertension, which may serve as an attractant to participants. No other inconveniences or discomfort is expected for participation in the study. Hypertension will be measured as a part of their regular exam schedule and assessed by their treating physician.

External validity considerations: This study will involve a select group of women within a certain age group. It cannot be assumed that similar results will be obtained in other age categories. One of the factors that may affect generalization is the unique hormonal changes in women in the target age category. Another factor consider in the ability to generalize the study results are the exclusionary conditions. In women with these conditions, similar results could not reasonably be expected.

Measurement section:

Measurement: In this study, the only two relevant variables are the presence or absence of hypertension and stress level. The lever of measurement for the groups will be nominal, with none of the groups receiving a higher priority than the others. Both the measurement of hypertension and the assessment of stress will… [END OF PREVIEW] . . . READ MORE

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