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W C Siegel

Publications and source records attributed to W C Siegel.

12 recordsLinked to original sources
PubMed1995

Contribution of job strain, job status and marital status to laboratory and ambulatory blood pressure in patients with mild hypertension.

The effects of job strain, occupational status, and marital status on blood pressure were evaluated in 99 men and women with mild hypertension. Blood pressure was measured during daily life at home and at work over 15 h of ambulatory blood pressure monitoring. On a separate day, blood pressure was measured in the laboratory during mental stress testing. As expected, during daily life, blood pressure was higher at work than at home. High job strain was associated with elevated systolic blood pressure among women, but not men. However, both men and women with high status occupations had significantly higher blood pressures during daily life and during laboratory mental stress testing. This was especially true for men, in that men with high job status had higher systolic blood pressures than low job status men. Marital status also was an important moderating variable, particularly for women, with married women having higher ambulatory blood pressures than single women. During mental stress testing, married persons had higher systolic blood pressures than unmarried individuals. These data suggest that occupational status and marital status may contribute even more than job strain to variations in blood pressure during daily life and laboratory testing.

Adult↗
PubMed1995

Ethnic differences in hemodynamic responses to stress in hypertensive men and women.

Hemodynamic response patterns to three laboratory stressors were compared in 63 mildly hypertensive black and white men and women. Ethnic groups were matched for age, body mass index, and casual blood pressures. Stressors included a mental arithmetic task, a simulated public speaking task, and a forehead cold pressor test. Blood pressure increases during the stressors were similar in the two ethnic groups. However, the pressor responses were mediated by greater vascular tone in black compared to white subjects. These differences persisted whether the hemodynamic response pattern was associated with an overall fall (speech task) or rise (cold pressor) in systemic vascular resistance. Gender differences in the hemodynamic basis of pressor responding were also observed. Women, compared to men, exhibited greater increases in heart rate and smaller vascular contributions to their blood pressure increases during stress. Ethnic and gender differences are discussed in terms of the neurohumoral mechanisms mediating the cardiovascular stress response. The findings are consistent with converging evidence suggesting that beta-adrenergic receptor down-regulation is characteristic of hypertension in whites, whereas heightened vascular alpha-receptor sensitivity or early vascular hypertrophy may be a feature of hypertension in blacks.

Adult↗
PubMed1993

Effects of aerobic exercise on cognitive and psychosocial functioning in patients with mild hypertension.

The effects of 16 weeks of physical exercise training on the psychological functioning of 90 patients with mild hypertension were examined. At baseline and after 16 weeks of training, patients completed a psychometric test battery that included objective measures of neuropsychological performance and standardized self-report measures of psychosocial functioning. Patients were randomly assigned to one of three groups: aerobic exercise, strength training and flexibility exercise, or a waiting list control group. After training, there were no group differences on any of the psychological measures, even though patients who engaged in exercise perceived themselves as functioning better in a number of psychological domains.

Adult↗
PubMed1991

Failure of exercise to reduce blood pressure in patients with mild hypertension. Results of a randomized controlled trial.

OBJECTIVE: --To assess the effects of physical exercise training on blood pressure in patients with mild hypertension. DESIGN: --Randomized controlled trial. SETTING: --Hospital-based cardiac rehabilitation program. PATIENTS: --Ninety-nine men and women with untreated mild hypertension (systolic blood pressure, 140 to 180 mm Hg; diastolic blood pressure, 90 to 105 mm Hg) were included in the volunteer sample. INTERVENTIONS: --Subjects were randomly assigned to a 4-month program of aerobic exercise training, strength and flexibility training, or to a waiting list control group. MAIN OUTCOME MEASURES: --The main outcome measures were systolic and diastolic blood pressures measured four times with a random zero sphygmomanometer on 3 separate days in a clinic setting. RESULTS: --After 4 months of exercise training, subjects in the aerobic exercise group did not exhibit greater reductions in blood pressure than subjects in the control group. We expected a differential decline of 5 mm Hg between the aerobic exercise and waiting list control groups and found a difference of -1.0 +/- 16 mm Hg and -1.2 +/- 10 mm Hg at alpha = .05 for systolic and diastolic blood pressure, respectively. CONCLUSIONS: --Moderate aerobic exercise alone should not be considered a replacement for pharmacologic therapy in nonobese patients with mild hypertension.

Adult↗
PubMed1990

Effect of Type A behavior on exercise test outcome in coronary artery disease.

The outcome of the diagnostic exercise test depends on such patient-related factors as age, maximum exercise heart rate, exercise time and severity of the underlying coronary artery disease (CAD). This study examined the hypothesis that type A behavior would affect the amount of effort expended, as indicated by the exercise time and the maximum heart rate achieved, thereby resulting in differences in exercise test outcome. A total of 1,260 patients with suspected CAD, all of whom had coronary angiography, a structured interview to assess type A behavior and a treadmill exercise test, participated. Of these patients, 818 (65%) had significant CAD, and 852 (68%) were type A. There were no differences between type A and B patients in either maximum heart rate or total exercise time. Among both type A and B subjects, 36% of treadmill tests were positive. Exercise test sensitivity was similar for both groups (69% for type A vs 72% for type B, p = 0.39). Similarly, specificity was similar for both groups (87% for type A vs 80% for type B, p = 0.09). Results did not change after using logistic regression to control for potential confounding factors. Thus, type A behavior does not need to be taken into account when interpreting exercise test outcome.

Adult↗
PubMed1990

Physiological, psychological, and behavioral factors and white coat hypertension.

Patients with hypertension in the clinic but not during daily activities ("white coat" hypertension) may be at lower risk of hypertensive morbidity and mortality than patients with hypertension in both settings ("persistent" hypertension). We hypothesized that the white coat phenomenon was due to greater blood pressure reactivity to the stress of a clinic visit and that, as a consequence, white coat hypertensive patients would display greater blood pressure reactivity to exercise and mental stress, as well as increased emotional reactivity and higher levels of anger, anxiety, or depression. We studied 89 patients with essential hypertension between 29 and 59 years old with ambulatory blood pressure monitoring, treadmill exercise testing with oxygen consumption measurement, mental stress testing (including mental arithmetic, public speaking, and video game tasks), and psychological testing (State-Trait Anxiety Scale, Cook-Medley Hostility Scale, Center for Epidemiologic Studies Depression Scale, emotional reactivity scale). We defined white coat hypertension as a mean ambulatory systolic blood pressure of 135 mm Hg or less and diastolic 85 mm Hg or less and persistent hypertension as a mean ambulatory systolic blood pressure of 140 mm Hg or more or diastolic 90 mm Hg or more. Forty-nine patients were classified as persistent hypertensives and 20 as white coat hypertensives. No significant differences were seen in demographic or clinical characteristics, fitness level, blood pressure response to exercise or mental stress, or psychological characteristics, except that white coat hypertensive patients had lower systolic blood pressures in the clinic and during exercise and greater variability of clinic diastolic blood pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Clinical correlates and prognostic significance of type A behavior and silent myocardial ischemia on the treadmill.

Type A patients with coronary artery disease (CAD) tend to ignore or underreport symptoms, especially during challenging tasks such as the treadmill exercise test. To determine whether type A CAD patients might be more likely than type B patients to have silent ischemia during exercise and consequently a worse prognosis, 403 patients with stable CAD who had significant coronary disease on angiography, a positive Bruce protocol treadmill test and a structured interview to assess type A behavior were studied. Median follow-up time was 6 years. Type A patients were more likely to experience silent ischemia during exercise than were type B patients (35 vs 25%, p = 0.05). Patients with silent ischemia during exercise had a history of fewer anginal episodes/week, and type A patients with silent ischemia were less likely to have had a history of typical angina. However, using the Cox model, there were no significant differences in survival between type A patients and B patients with silent ischemia (4-year survival 86 vs 79%, p = 0.44) and no significant differences in survival between type A patients with silent ischemia and type A patients with symptomatic ischemia (6-year survival 86 vs 80%, p = 0.59). Similar results were obtained for infarction-free survival. Type A patients are more likely than type B patients to have silent ischemia during exercise, but long-term survival is not affected.

Angina Pectoris↗
PubMed1988

Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills. A randomized control trial.

The journal club is an established teaching modality in many house-staff training programs. To determine if a journal club improves house-staff reading habits, knowledge of epidemiology and biostatistics, and critical appraisal skills, we randomized 44 medical interns to receive either a journal club or a control seminar series. A test instrument developed by the Delphi method was administered before and after the interventions (mean, five journal club sessions). By self-report, 86% of the house staff in the journal club group improved their reading habits vs 0% in the control group. Knowledge scores increased more in the journal club group than in the control group, and a trend was found toward more knowledge gained as more sessions were attended. Ability to appraise critically a test article increased slightly in each group, but there was no significant difference between the groups. We conclude that a journal club is a powerful motivator of critical house-staff reading behavior and can help teach epidemiology and biostatistics to physicians-in-training.

Biometry↗
PubMedDate not supplied

Hypertension affects neurobehavioral functioning.

This study compared the neurobehavioral performance of hypertensive and normotensive men and women using neuropsychological, information-processing, and psychometric assessments. One hundred subjects, including 68 hypertensive and 32 normotensive individuals, completed a test battery that yielded scores on measures of speed of information processing, verbal and figural memory, psychosocial functioning, Type A behavior, and locus of control. Results showed that, compared with the normotensive individuals, the hypertensives performed more poorly on a set of tasks that measure speed of information processing and short-term memory (Digit Symbol, Digit Span (Backwards), and Reaction Time (slope)). The hypertensives also reported higher levels of state anxiety relative to their normotensive counterparts. The effects of hypertension on neurobehavioral functioning could not be accounted for on the basis of age or education.

Adult↗