高血壓原因

(A) 身、心醫學 (bio-psychosocial model, Engel , 1977),身、心治療

 1) 繼發性 - 腎病、腎上腺瘤等。

2) 原發性 - 原因是

   a) 生活行為 - 鹽的攝入量多,缺乏運動,肥胖,吸煙;

   b) 表觀遺傳學,生活事件信息,自己習慣選擇不安,引致意識壓力 (distress) (http://www.ncbi.nlm.nih.gov/pubmed/22021460 )  (http://www.ncbi.nlm.nih.gov/pubmed/9894438) 或潛意識思想壓力累積心結 (repression*,可學習練習心理技術去自我控制) 引致 -

         i) 身體外觀整體行為 - 生活行為壞習慣 (鹽的攝入量多,缺乏運動,肥胖,吸煙)。

         ii) 身體內(細胞)行為 - 

             -  腎上腺荷爾蒙正常地失調如皮質醇 (cortisol)

              http://hyper.ahajournals.org/content/36/5/912.full

                                   ,醛固酮 (mineralocorticoid),腎上腺素 (adrenaline), EPO

             -  刺激交感神經、刺激腎上腺荷爾蒙。

    c) 遺傳,基因

 

 (B) 身體醫學 (主流, bio-medical model, Virchow, 1858),身體治療

1) 繼發性 - 腎病、腎上腺瘤等。

2) 原發性 - 原因不明,但和下列原因有關。

   a) 生活習慣行為,主要自己負責 - 壓力,鹽的攝入量多,缺乏運動,肥胖,吸煙;

   b) 遺傳,基因 (不可自我控制)。

 

 

 

心理治療抑制交感神經系統,醫血壓*,減少加藥或用手術醫血壓機會

錯誤黑白思維 ( all or none common thinking error) -

      思想的錯誤問題 - 高血壓是否生活壓力引致?

      更好問題 - 生活壓力,甚麼情形下、影響多少高血壓?瞬態高血壓或持續性高血壓重要性的分別。

 

Emotional Brain Control:

 http://www.youtube.com/watch?v=2g1_y8ZzTbk&feature=related

 

焦慮可以是內心(潛意識)或外表(意識)。

      是否焦慮對每一個人的血壓有一致性影響,才可以認為焦慮引致長期血壓高而去同時處理壓力 (找健康方法 - 好副作用),否則仍集中物質醫病方法、物質框內思維 (藥、手術醫血壓高 - 壞副作用)。個人心理性格分別、長短期影響可以不理? (public health statistics vs private health)。

 

*Reference:    The Divided mind                                                                  

Chapter 5 - Hypertension and mindbody connection: a new paradigm,Unconscious Repression -  童年的經歷形成腦細胞網絡、刺激交感神經和高血壓。用心理治療抑制交感神經系統,醫頑固血壓高。

 

 

 

 

要練習減少產生壓力荷爾蒙。習慣負面思維驅動急性情緒化的人,醫學證明長遠增加血壓惡化 ( http://www.ncbi.nlm.nih.gov/pubmed/22021460  

Psychosom Med. 2011 Nov-Dec;73(9):737-42. Epub 2011 Oct 21. Blood pressure reactions to acute mental stress and future blood pressure status: data from the 12-year follow-up of the West of Scotland Study)。  

 http://www.medscape.com/viewarticle/704866_4

 

手術治療抑制交感神經系統,醫血壓,減少加藥醫血壓機會

        20年前 血壓160 定義 等於剛開始血壓高要用藥,現負面思維推動自以為血壓160未降 「很快」有併發病,血壓唔降唔安心?甘冒可能未知手術中期長遠風險為了短期安心(數字效果)? 又一置安心預防手術? 研究當治療 (Therapeutic Misconception, Appelbaum, 1982)?

 

研究以為治療的誤解?

http://en.wikipedia.org/wiki/Therapeutic_misconception  Therapeutic misconception did not receive great attention in the years following its formulation but this changed in the early 2000s, when its use expanded significantly.) ?

 

http://www.ardian.com/pdfs/LINC%20Presentation%20Scheinert%20January_28_2010.pdf

      cardiac death  "considered"  = "belief"

 

主觀相信不是「安慰手術」之安慰效果

"Although there are as yet no controlled clinical trials (non- double blind evidence based surgery), it is difficult to believe that these observations are the product of a placebo response."  (http://www.springerlink.com/content/v2413816256t8r78/fulltext.html)。 (? all or none common thinking error as if observations cannot be partly due to sham surgery effect)

vs sham surgery (安慰手術) example   " In a number of situations, sham-controlled interventions have identified interventions that are useless but had been believed by the medical community to be helpful based on studies without the use of sham surgery." (  http://en.wikipedia.org/wiki/Sham_surgery )

 

作為研究之手術6個月不淮轉藥

http://www.theheart.org/article/1440487.do

 

Physicians were allowed to change the patients' medications following the six-month primary end point.

The reasons for any changes are unknown, but Esler said that, if anything, these changes would bias the sustained improvements in blood pressure seen in the trial. "In my own experience, this is often driven by patients. They don't want to be on drugs after the procedure, so [reducing their medications] is a sign of progress. They want to be cured by denervation—which no one, of course, is—[but] there's a tendency for us to undermedicate over time."


Esler acknowledged that "with any device trial, there may be a greater placebo effect than in a drug trial." This "deficiency is being corrected" in the pivotal SYMPLICITY HTN 3 in which patients in the control group will have a "sham" procedure.

significant improvement on a multitasking test designed to assess their ability to respond to stress. Average scores of quality of life, anxiety, and depression all increased significantly, and the decreases in headache intensity and sleep problems were also significant.