The Learning Blog

From Medscape Medical News

A study presented at the Society of Behavioral Medicine meeting reported that women’s blood pressure lowers faster after an apology from an insult than men.

The study tries to investigate the physiological effects of forgiveness in real-time situation as opposed in some previous studies where transgressions were imagined.

79 participants (29 men and 50 women) were tested for levels of forgiving using the Forgiving Personality Inventory. The participants were tasked to perform a mathematical problem and were subjected to multiple interruptions interjecting with insulting remarks.

The Forgiving Personality Inventory assesses a person’s forgiving personality.

40 of the participants received an apology from the experimenter.

Those who had higher forgiveness score showed faster recovery of the diastolic blood pressure (DBP = 4.88 mm Hg) and mean arterial pressure (MAP = 3.96 mm Hg) after the apology.

Additionally, women who scored high in forgiveness had lower DBP when compared with lower scores.  Women who received an apology recover faster than those who did not. In men, the effect was reversed – those who receive an apology had higher DBP and MAP than those who did not.

In short, the study gives as a real-time view of what happens in individuals who were provoked and were either apologized or not. With this, an individual who was insulted or harmed and received an apology experienced greater reduction of stress on the heart but the health benefits of this is however sex-dependent.

Comment:

Forgiveness, as McCullough and Witvliet observed, has one common denominator: When one forgives, their responses (what they feel, think, do and behave) towards the people who have offended or harmed them becomes less negative and more positive or prosocial over time.

I’m sure all of us, in one way, were put in a situation where we were insulted or harmed and were either apologized to or not. We can immediately feel the sense of having a “heavy weight taken off our chest” when we sincerely forgive or were forgiven or reparations were done.

Christians have very good examples of forgiveness in the Bible as I’m sure other religions have as well. The story of the Prodigal Son comes to mind. Catholics have a sacrament called Reconciliation where forgiveness is the aim in people who take part in this.

Psychologists measure forgiveness as either by state or trait. The state of forgiveness looks at how an individual remembers a specific betrayal situation. The trait of forgiveness looks at how forgiving the individual is.

In October 2003, researchers from the University of Kentucky reported in the Journal of Behavioral Medicine said that people who are forgiving by nature and are able to forgive after an interpersonal conflict have lower blood pressure and better cardiovascular status. There was also faster recovery of the diastolic blood pressure in people who has the forgiveness trait.

A study from the German Institute of Human Nutrition in Nuthetal, Germany reported that those who ate the most chocolate—around 7.5 g per day—had a lower risk of myocardial infarctions or heart attacks and stroke as compared with individuals who does not or eats less chocolate. The study is considered as the largest observational study to look into the association of chocolate with heart disease.

This shows that habitual consumption of chocolate is related to a lower risk of heart disease and stroke that is partly explained by blood-pressure reduction. The risk reduction is stronger for stroke than for MI, which is logical because it appears that chocolate and cocoa have a pronounced effect on BP, and BP is a higher risk factor for stroke than for MI. – Dr. Brian Buijsse, lead author

But hold on a minute, people however are still warned that chocolates also contain lots of sugar and calories. What does that mean? Too much caloric intake means putting more weight and being overweight or even obese is already considered an epidemic in some developed and probably developing countries. So we still need to be careful of how much and what we eat.

Other Salient Points:

• A healthy chocolate means those dark bitter ones. They contain a significant amount of cocoa  which contains flavanols and give the health benefits of chocolate. “Dark chocolate” means to have at least 70% cocoa content.
• It is thought that flavanols release nitric oxide which dilates the blood vessels and subsequently lowering the blood pressure and improve platelet function.
• The study followed around 19,000 people for eight years.

Want to know more? Click here.

This is one more reason to eat your vegetables. Researchers from Northwestern University in Chicago, USA recently reported that dietary glutamic acid may have blood pressure-lowering effects, which may contribute to the inverse relation of vegetable protein to BP. More »

Previously, I had the opportunity to mention two studies related to sleep and hypertension and/or heart disease. First was the HYENA study (Hypertension and Exposure to Noise near Airports) published in the European Heart Journal where researchers found that moderate noise even in sleep can elevate blood pressure. The second study was with Japanese patients and reported in the Annals of Internal Medicine, where researchers found that people who consistently sleep less than 7 hours of duration can increase their chance of heart disease. More »

Last April 2009 a study was published in the Archives of Pediatrics and Adolescent Medicine which reported that sweetened beverages and physical inactivity were independently linked to insulin resistance in adolescents.

More »

Last May, the Public Library of Science (PLoS) Pathogens published a report headed by a team of researchers from Beth Israel Deaconness Medical Center which found that a very common pathogen, cytomegalovirus (CMV), and which infects more than half of the world’s population, can be a cause of high blood pressure.

More »

A Brazilian study found that there is an increased risk for microvascular complications in diabetic patients having white-coat hypertension (WCH).

Dr. Caroline Kramer and colleagues at the Hospital de Clinicas de Porto Alegre identified 46 diabetic patients who had normal ambulatory blood pressures but had elevated BP in the clinic.

These subjects were compared with 117 people with normal BP for both ambulatory and clinic settings.  The study found that patients with WCH had increased risk for both diabetic nephropathy and diabetic retinopathy.

The group advised not to consider WCH as a harmless condition and patients with WCH must be treated accordingly.

Comment:

As was described above, white coat hypertension is a phenomenon when an individual will present with a high blood pressure while in a physician’s office, but will have a normal blood pressure outside the clinic. It is usually attributed to possible stress or anxiety prior to or during the taking of the blood pressure.

Personally, I have seen a few patients with this condition though I’m not going to conclude immediately that this is a rare finding. Some patients would present to the clinic as having a high blood pressure but would also tell me that they have a normal BP at their home or in some other place. What I recommend is to have them keep a diary of their BP if I think that they need to be monitored. Unless a patient is able to afford one, an ambulatory blood pressure machine is not really necessary, but a diary that has the BP reading, the time, date, and place where they had their reading taken and who took them is enough.

A good advise is the preparation of the patient prior to the BP taken. Relax for 5 minutes, no caffeine-containing beverages,  empty bladder and no heavy meal.

In this study, the message is clear: don’t take WCH for granted. Though we may attribute this to a possible “psychological” factor, WCH can be a force to reckon with especially to people with diabetes. So regular monitoring of BP, sugar levels, and urinalysis are important for this particular group of diabetic patients.

Image from Veer.