The role of stress and the sympathetic nervous system in hypertension and ischemic heart disease: advantages of therapy with beta-receptor blockers.

Human and animal studies link social and environmental factors to hypertension and ischemic heart disease. Job stress and undesirable life events may precede the development of raised blood pressure. Hypertension and ischemic heart disease vanquished many of the survivors of the seige of Leningrad. Specific behavior patterns of some patients with ischemic heart disease and the psychological ambience of others with hypertension have been associated with raised neural tone as reflected by levels of plasma norepinephrine and epinephrine. Sympathoneural hypertonicity is a factor in left ventricular hypertrophy and the latter has been a prophet for sudden cardiac death. Sympathoadrenal surges may contribute to both reduced coronary reserve in hypertensives and increased vulnerability to ventricular dysrhythmia. The "coronary epidemic" of our modern times appears related in part to outdated survival mechanisms, not suitable to human behavior in our urban milieu. Beta receptor blocking agents are effective antidotes providing protection from adrenomedullary overdrive and even perhaps, modification of that behavior. Stress and the sympathetic nervous system are important co-conspirators in hypertension and sudden cardiac death.