Schwartz G E, Shapiro A P, Redmond D P, Ferguson D C, Ragland D R, Weiss S M
J Behav Med. 1979 Dec;2(4):311-63. doi: 10.1007/BF00844739.
This article compares behavioral and biological approaches to hypertension, highlights some of the practical, semantic, and theoretical issues involved, and attempts a constructive, behavioral medicine integration of these approaches. The major behavioral approaches to hypertension are described, with a focus on their conceptual limitations as stimulants to research into psychobiological mechanisms. A biobehavioral systems analysis of hypertension is outlined, emphasizing the role of the central nervous system as a common pathway relating environmental and behavioral factors to cardiovascular regulatory dynamics and disease. Schwartz's concept of blood pressure disregulation is discussed, by which behavioral "feedback loops" may be included in the pathogenesis of homeostatic disorders. A detailed discussion of concepts underlying the clinical pharmacological approach to hypertension is provided; parallels are drawn between the conceptual framework and the theoretical and practical questions facing behavioral researchers concerned with hypertension. Synergistic interactive effects of drug and behavioral treatments are proposed. A biobehavioral overview, which links pressor and depressor stimulus patterns to both pathogenesis and therapy, can serve to integrate the previous biobehavioral systems analysis, the conceptual framework of clinical pharmacology, and the notion of biobehavioral disregulation of blood pressure. Implications for future behavioral medicine research in hypertension are provided.
本文比较了治疗高血压的行为学方法和生物学方法，强调了其中涉及的一些实践、语义和理论问题，并尝试对这些方法进行建设性的行为医学整合。文中描述了治疗高血压的主要行为学方法，重点关注其概念局限性，这些局限性刺激了对心理生物学机制的研究。概述了高血压的生物行为系统分析，强调中枢神经系统作为将环境和行为因素与心血管调节动态及疾病联系起来的共同途径的作用。讨论了施瓦茨的血压调节失调概念，据此行为“反馈回路”可能包含在稳态紊乱的发病机制中。详细讨论了高血压临床药理学方法背后的概念；在概念框架与关注高血压的行为研究人员面临的理论和实际问题之间进行了比较。提出了药物治疗和行为治疗的协同交互作用。一种将升压和降压刺激模式与发病机制及治疗联系起来的生物行为概述，可用于整合先前的生物行为系统分析、临床药理学的概念框架以及血压生物行为调节失调的概念。还提供了对未来高血压行为医学研究的启示。
