Psychosocial influences on blood pressure during daily life.

Ambulatory blood pressure (ABP) monitoring allows frequent non-invasive blood pressure (BP) recordings in a variety of settings. Emerging evidence suggests that ABP is a better predictor of cardiovascular morbidity than clinic BP. Ambulatory blood pressure is influenced by a variety of physical, psychological and behavioral factors that comprise an individual's daily life. The present article reviews psychosocial research relating ABP to psychological factors (e.g. Type A behavior pattern, anger/hostility) and environmental influences (e.g. job strain). Psychological factors and environmental factors alone and in interaction with each other appear to substantially influence ABP. Interacting physical, psychosocial and behavioral factors that comprise daily life provide unique methodological challenges to ABP research. Methodological considerations (e.g. activity patterns, caffeine and alcohol consumption) for performing ABP research are discussed. Evidence outlined in this review suggests that psychosocial factors contribute to ABP level. To the extent that psychosocial factors contribute to ABP cardiac disease, it will be important to analyze their effects on underlying disease processes.