By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Over the years, my staff and I took thousands of blood pressure readings. Just like in many other medical offices, a good number of patients would become quite nervous in those situations. Their anxiety would set off a phenomenon referred to as “white coat hypertension,” meaning unusually elevated blood pressure that might not otherwise occur. We would always try to calm down such patients and tell them to close their eyes and think of lying on the beach in Florida or playing with the grandkids – anything pleasant.
During my active practice days I also became aware of spikes in blood pressure numbers when people talked a lot while we were trying to get an accurate reading. This observation was another reason why I asked people to just try and sit in silence for a moment while I checked them out.
What is it about communicating and talking that raises the blood pressure? It’s true. The research indeed says that talking increases blood pressure instantaneously in hypertensive patients. Research also says that in general the physical act of talking, public speaking, recalling anger, and intense discussions all produce significant rises in pressure, activation of the body’s stress-related sympathetic and neurohormonal systems, and constriction of peripheral arteries.
For many people, the connection involves the act of expressing something stressful and even goes to deep-seated emotions stemming from early childhood and fearing that our cries are not heard.
Some years ago I contacted Jim Lynch, Ph.D., to ask him about this connection. Jim is an absolute expert on the heart and mind connection, including the subject of talking and blood pressure. His books, including The Broken Heart: The Medical Consequences of Loneliness (1979), and A Cry Unheard: New Insights into the Medical Consequences of Loneliness (2000), have taught me a good deal about how stress affect the body.
Hypertension – A “Communication Disorder”
In 1981, while a researcher at the University of Maryland, he designed a study showing that blood pressure increases rapidly during speaking and returns to baseline with equal rapidity after speech. Individuals with the higher pressures tend to have greater increases during talking.
“So hypertension is, to a substantial degree, a communication disorder. The more rapidly you speak the higher your pressure goes up,” he told me.
Jim spent some 20 years working as a psychologist in a cardiac rehab center seeing patients after bypass surgery or stent implantation. His role was to provide the psychology part of the standard American cardiology mandate of exercise, diet, and stress counseling. He routinely saw patients a half-hour after exercise on the treadmill when their blood pressure had topped as a result of maximum exercise. The patients would come to talk to him. Stressful topics were avoided.
“The results were consistently amazing,” he said. “All of those people developed much higher blood pressure talking to me than they had at max exercise! If you are looking for a dramatic way to get people to look at the mind-body connection, this is it. Some of those people were on 10 different medications and not one medication blocked this effect.”
The Holocaust Example
As someone trained in psychotherapy and who consistently addressed the mind-body connection in my practice, I’m well aware of the two sides of the cardiac coin: the emotional-communicative heart and our mechanical heart. They operate quite differently and the influence of the former can be quite dramatic on the latter. This is particularly evident when someone talks about loss.
As an example of that, Jim Lynch described to me his unique experience with Holocaust survivors. He believes he has interviewed more Holocaust survivors while monitoring their cardiovascular system than anybody in the world.
“These patients might have 120-60 blood pressure on average until they start talking about a concentration camp experience and then their pressure goes to 220/120,” he said. “The question then becomes should they then talk about it or not talk about it? Because speaking of the unspeakable is putting them at great risk. In modern psychological thinking we have the notion of catharsis, of letting it out. However, for these people, it is harmful. You can’t just regurgitate your feelings about Buchenwald and it’s gone. It doesn’t help. You can talk about it a thousand times and the pressure will still skyrocket.
“What’s involved here is the actual act of communicating something to our fellow man that puts us in a fight-or-flight mode. It is not just that these people are struggling with the issue of the past, but it is who, what, and how can they communicate with others about the problem.
“I’ve done amazing experiments with Holocaust survivors, and the situation is the same. I would ask them to think for about five minutes about the worst things that happened in the camps. There is no change in blood pressure. I then asked them to tell me what they were thinking about. Boom. Their pressure would double.”
When Jim mentioned that to me, I immediately recalled the case early in my career of a decorated Marine who had fought in Viet Nam. He was patient of mine who’d had a heart attack. I was with him in the catheterization lab doing a ventriculogram procedure. That’s an imaging technique utilizing a tiny camera that films, like a motion picture, the pumping activity of the heart’s ventricular chamber. At the time I was studying the relationship of stress to cardiac function and wanted to measure the pressure within the heart. The catheter, with the camera, was in his left ventricle. As we had arranged, I asked him first to think about his combat experiences. He did and nothing happened. There was no change in the picture. Then I asked him to look at the images of his damaged heart and tell me what he was feeling. He became agitated and expressed his fear and anxiety. As soon as he started communicating, the ventriculogram went crazy and the pressure in his heart almost doubled. I reported this incident in a medical journal article as an example of how stress can quickly and negatively affect the heart.
We tend to think of talking as something merely mental, but it can muster up all kinds of images that create an explosive fight-or-flight reaction in the body. And it is not only stress playing out. It is the simple act of speaking. Pressure rises when you speak. It drops below normal when you listen. People who listen more as a whole have lower blood pressure.
Problem is that everybody has something to say, especially Type A individuals. You’ve no doubt noticed that. They are driven to be heard. And people who speak often and rapidly also have an additional problem in this respect. According to Jim Lynch: “When they listen they are also thinking about what they want to say next.”
You also may know many people, who perhaps never felt heard in their young lives, and who never stop talking when they got older. They become “chatterboxes!” Whenever I encountered hypertensive talkers in my practice I would always insist on verbal restraint. To me, “chatterbox-related hypertension” was a real entity.
Public speaking has been studied as a form of stress that can cause blood pressure to rise. We know that when you talk and are stressed, you instantly constrict your peripheral blood supply. A healthy heart pumping out a lot of blood against a constricted periphery can create huge pressure surges that go right up into the coronary arteries and could even damage the sensitive endothelial lining of arteries. This is an unheralded mechanism that can contribute to arterial disease.
The Sinatra Solution: Become a Better Listener
As a youngster I used to stutter. The biggest challenge, or fear, for me was talking in any kind of a public setting, such as school. Yet I obviously grew out of the stuttering and the fear. Nowadays when I speak to audiences, sometimes as big as 2-3,000 people, I am fearless. The words flow. I think that comes from speaking from the heart. If we just speak from our hearts, we are speaking for what is for us the truth. Our hearts and bodies are in sync.
The notion of speaking in public, whether in front of audiences or friends, is stressful only to the degree that you feel you can communicate. If you speak the truth, and you feel heard, it is not that stressful, and so less blood pressure-altering.
If you do have high blood pressure, think about what I just said. Try to become a better listener.
- Lynch JL, Long JM, et al. The effects of talking on hypertenhsive and hypotensive individuals. Psychosomat Med, 1981;43(1): 25-33.
- LePailleur C, Montgermont P, et al. Talking effect and “white coat” effect in hypertensive patients: physical effort or emotional content? Behav Med, 2001;26(4):149-57.