The relationship between exposure to violence and blood pressure mechanisms.

Although previous research has indicated a link between environmental stress and essential hypertension, little is known about the role of violence exposure on risk for developing essential hypertension. Violence exposure, defined as experiencing, witnessing, or hearing about violence in the home, school, or neighborhood, is a serious societal problem. Approximately 70% of inner-city youth have been victims of violent acts, and approximately 85% of these youths report having witnessed violent acts. In this review, several possible paths are proposed to explain the link between exposure to violence and cardiovascular health outcomes (eg, physiologic and psychosocial). Several contextual models are outlined, and a review of the empirical evidence suggests that chronic environmental stress (eg, violence exposure) might play a role in the development of essential hypertension. The mechanisms underlying the effects of violence exposure on blood pressure are unknown, although preliminary evidence suggests that elevated sympathetic nervous system activity may be involved. Several possible psychosocial mechanisms are outlined that might also link violence exposure to physiologic blood pressure-related mechanisms. Prevention and intervention efforts to reduce community violence are reviewed, and a call is made for encouraging further research on this critical topic.