Observations of Nitrite-Induced Postural Syncope in Patients with Mental Disease

Altschule, Mark D.; Lorenz, Matthew C.

doi:10.3181/00379727-71-17059

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Effect of Breath Holding on Arterial Pressure in Patients With Mental and Emotional Disorders

Altschule¹

1952

Arch NeurPsych

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THE RELATION of emotion to elevation of arterial pressure has been discussed in the medical literature since essential hypertension was first recognized. Although ample evidence exists that an emotional upset may cause temporary elevation of arterial pressure, there are differences of opinion concerning its importance as the cause of essential hypertension. Among the findings in patients with essential hypertension, as well as in some of their normotensive siblings, is an excessive rise in arterial pressure when carbon dioxide accumulates in the blood during voluntary suspension of breathing.1 It was therefore considered desirable to study the effect of breath holding on arterial pressure in patients with emotional disturbances. The study also afforded information concerning the reactivity of the vasomotor system in the psychoses studied. MATERIAL AND METHODSSeventy-nine patients, of whom 51 were women, were studied by the method of Ayman and Goldshine.1 The patients were at rest during and for a period prior to the test, but the half-hour pretest rest period recommended by Ayman and Goldshine 1 could not always be enforced. The diagnoses for the patients studied included the common mental and emotional disorders (Chart) ; 13 of the subjects exhibited diastolic blood pressure levels of 90 mm. Hg or above. OBSERVATIONS Increases in systolic and diastolic blood pressure during 20 seconds of breath holding were between 0 and 22 mm. Hg in 77 of 79 patients; in only 2 patients were the rises 23 mm. Hg or more. Changes in arterial pressure were the same in range and distribution in all the diagnostic categories studied. COMMENT Patients with essential hypertension regularly exhibit excessive rises in arterial pressure during breath holding1; a similar phenomenon occurs in some of their normotensive siblings. The cold-pressor test yields similar increases.2 Vaso-

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