Esansiyel Hipertansiyonda Psikolojik Etmenler

Esansiyel hipertansiyon üzerinde en çok durulan psikosomatik hastalıklardan biridir. Yaş, cinsiyet, yüksek miktarda tuz ve alkol tüketimi, obezite, yüksek kalorili beslenme, düşük aktivite düzeyi, yorgunluk, kişilik özellikleri, stres gibi duygusal etmenler esansiyel hipertansiyon etiyolojisinde rol oynayan bazı risk faktörleridir. Hipertansiyon, hem etiyolojisinde duygusal nedenlerin rol oynaması hem de seyri sırasında psikiyatrik belirtilerin ve bozuklukların ortaya çıkması nedeni ile ruh sağlığı çalışanları tarafından yıllardır araştırılmaktadır. Yapılan çalışmalarda; aşırı kontrollü ve uyumlu olma, işte sürekli çaba gösterme, agresif dürtüleri bastırma gibi özelliklerin hipertansiyona yatkınlığa neden olduğu gösterilmiştir. Hipertansiyonun baskılanmış duygulara karşı bir tepki, bir uyum ve savunma mekanizması olduğu kabul edilmektedir. Hipertansiyona yatkın kişilerde, duygusal streslere cevap olarak sempatik sinir sisteminin etkilendiği, vasküler vasokonstriksiyon ve diğer otonomik cevapların sonucu olarak hipertansiyon ortaya çıkmaktadır. Strese vasokonstriktör cevabın hipertansif olanlarda, tansiyonu normal olanlara göre çok daha uzun olduğu da gösterilmiştir. Hipertansiyona yatkın olan kişilerde, strese karşı otonomik yanıt özelliği kan basıncının yükselmesi şeklindedir. Esansiyel hipertansiyonluların normal tansiyonu olan çocuklarında da duygusal streslere yanıt olarak kan basıncının yükseldiği gösterilmiştir. Esansiyel hipertansiyonda sempatik uyarı artışının kilit bir etmen olabileceği, baroreseptörlerin yapısal ve işlevsel değişiklikler göstererek yeniden düzenlendiği günümüzde en geçerli olan varsayımdır. Bu varsayıma göre; duygusal stres sonucu vazomotor merkez üzerindeki baskılanma azalır ve uyarı çıkışı artar. Ardından yeniden düzenlenme ile karotis sinüsü, aort kavsi ve vazomotor merkezlerdeki endotel örtüsünde epigenetik değişiklikleri oluşur ve bu değişiklikler sonrası stres sempatik sistemdeki uyarı çıkışını daha da çoğaltır. Sempatik sistemde uyarı çıkışının artması nörohormonal eksitasyona neden olarak sistemik damar direncini artırır. Dolayısıyla direnci artmış damarlardaki endotel hücreleri daha çok vazokonstriktör madde salgılamakta ve ortaya çıkan vazokonstriksiyon sonucu da hipertansiyon gelişmektedir. Bu zamana kadar yapılan çalışmalar, tutarlı biçimde hipertansif kişilerde duygusal faktörlerin ve belirli kişilik özelliklerinin hastalığı hazırlayıcı olduğunu göstermiştir. Bu yazıda esansiyel hipertansiyon ile psikolojik etmenler arasındaki ilişki gözden geçirilmiş, ortak patofizyolojik düzenekler tartışılmıştır.

Anahtar Kelimeler:

Hipertansiyon, Hipertansif Kişilik, Stress, Öfke, Psikosomatik Bozukluklar

Psychological Factors in Essential Hypertension

Essential hypertension is one of the most emphasized psychosomatic disorders. Age, sexuality, excessive salt and alcohol consumption, lower activity level, fatigue, personality traits, emotional factors and stress are some of the risk factors for essential hypertension. The presence of emotional factors in the etiology of the essential hypertension and the emergence of psychiatric symptoms in the course of the illness has driven considerable attention from mental health workers on the disease for a long time. Some of the personality traits that make a person vulnerable to hypertension are being over controlled, being submissive, and hardworking. Hypertension is accepted to be a reaction against suppressed emotions and an adaptive and defense mechanism of the body. Among persons who are prone to hypertension, sympathetic nerve system is affected as a response to emotional stress and hypertension appears as a result of vasoconstriction and other autonomous responses. All at once, it was also shown that vasoconstrictor response continues much longer in hypertensive individuals than in normotensive patients. Autonomic response to stress almost always displays itself as hypertension in individuals who are prone to hypertension. Moreover, normotensive children of hypertensive parents also have elevation in blood pressures as a response to emotional stress almost without exception. The increase in sympathetic stimulus, re-modulation of bar receptors by structural and functional changes are the main features of the most commonly valid hypothesis in essential hypertension, currently. According to this hypothesis: as a result of emotional stress, inhibition over vasomotor center decreases and output of stimulus increases; epigenetic changes in endothelial structure of carotid sinus and/or aortic arch and/or vasomotor centers occurs; and finally stress increases sympathetic stimulus output. This situation leads to neurohormonal excitation; increases in systemic vessel resistance; and in turn increase in the secretion of vasoconstrictor compounds from endothelial cells of over-resistant vessels. Hypertension develops as a result of vasoconstriction. In the previous studies, emotional factors and particular personality traits are consistently confirmed for being predisposing factors in hypertensive individuals. In this article, we focused on the association between essential hypertension and psychological factors, and discussed the common pathophysiological mechanisms.

Keywords:

Hypertension, Hypertensive Personality, Stress, Anger, Psychosomatic Disorders,

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ISSN: 1309-0658
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 2009
Yayıncı: Psikiyatride Güncel Yaklaşımlar

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