Motivation and emotion/Book/2013/Daily hassles and uplifts

Daily hassles and uplifts:
How do daily hassles and uplifts influence emotion?

Multimedia presentation (5 min)

Overview

“ Think for a minute about how you would describe your day, or your life in general. You may describe it in terms of the good encounters you have had, and how they made you feel. Maybe a stranger opened a door for you, leaving you smiling and feeling pretty pleased. Maybe you finished that all-consuming assignment. You may also describe the annoying problems you face – being late to work, not being able to find a car park once you got there, only to come home and continue arguing with your spouse like you do every night. You may feel terribly irritated. Our daily existence is made up usually of good and bad experiences, minor and significant. So in totality, how does the sum of these ‘minor’ instances effect our emotion and functioning in life? How can we not ‘sweat’ the small stuff, and enjoy our everyday? This chapter will examine these questions, and consider the overall question of how our daily hassles and uplifts affect our emotions. ”

What are daily hassles and uplifts?

Daily hassles relate to the irritating, frustrating, distressing demands that, as Kanner et al., (1981) appoints, characterise everyday transactions in the environment. It is those repeated, ongoing, chronic strains of life (DeLongis et al., 1982). It includes practical annoyances such as losing things, traffic jams, and the unexpected occurrences such as arguments with others, disappointments, and financial concerns (Kanner et al., 1981). The list is endless; it may be easy to call on a hassle encountered each day, every day. It is probable that nobody leads a hassle free life (Kanner et al., 1981). Not all hassles are equal, and can have varying influence on people’s life and overall perceived stress (McIntyre, Korn and Matsuo, 2007).

In contrast to the hassles we endure, there are also minor pleasures that characterise our daily events (Kanner et al., 1981). These minor uplifts relate to such instances as relating well to a spouse or lover, meeting your responsibilities, completing a task, and spending time with your family (Kanner et al., 1981). Like hassles, uplifts are viewed subjectively and have differing outcomes for individuals.

It has been proposed uplifts may present as a compensatory experience to the hassles we tolerate, warranting a role in evaluating the impact on stress (Lazarus et al., 1980; Kanner et al., 1981). It may be that uplifts may buffer the undesirable effects brought by daily hassles, while hassles too may dissipate positive effects uplifts create(Totenhagen et al., 2012). A mental weigh up occurs between the two experiences, and imbalances can lead to negative or positive emotions to persist. It is found that the experience of daily hassles can lead to negative affectivity, pervasive mood disposition, irritability, and sometimes eventuate to stress (Watson and Pennebaker, 1989). Uplifts can lead one to positive moods and optimism (Stone, 1987).

The first to theoretically propose the significance of hassles and or uplifts and their effect on everyday functioning was Lazarus et al., (1980). He proposed that the ‘overlooked’ minor stresses and delights of the day may significantly impact, and predict, adaptation outcomes such as general health. This was an extreme variation to the accepted notion that majorly distressing and significant life events led to impairing stressful states (McIntyre et al., 2007). It is now understood that the accumulated effect of the frustrating hassles experienced have a strong effect on perceived stress (McIntyre et al., 2007), sometimes greater so than our major life events (DeLongis et al., 1982). It has therefore been the subject of great research in understanding the shift from hassles to perceived stress.

How do you measure up?
Take the daily hassles and uplifts questionnaire to see your own experiences of hassles and uplifts and see how you compare to people in a similar demographic

"Don't sweat the small stuff" - The transfer from daily hassles to stress

Individual differences

How would you perceive daily hassles?.

While overlaps exist between individuals for what constitutes a hassle, there also lie large differences (McIntyre et al., 2007). What is perceived as stressful for one person, may not affect another, or even be regarded as an uplift (Rowden et al., 2006). Some may find spending time with their family as a hassle filled interaction, fueled by disagreements, arguments, and forced interaction. On the other hand, this family time may be viewed to another as uplifting and a delightful experience to share company with significant others. It is important to understand the differences people hold in evaluating what constitutes 'hassling' or 'uplifting'.

Personality differences for tolerating hassles also affect the perceived state of stress. Those with ‘mental hardiness’ are seen to appraise stressful situations as less overwhelming (Florian, Mikulincer, Taubman, 1995; Salvatore, 2005). Limited perceived control of one’s ability to cope with stress impacts negative appraisals of stress, while having an optimistic disposition can lead to more active coping and higher resilience (Fontaine, Manstead, Wagner, 1993). High levels of neuroticism predict more emotional distress and poorer coping, whereas high extraversion and conscientiousness relate to more positive affective styles, capacity for interpersonal closeness and flexible thinking (Campbell-Sills, Cohan, and Stein, 2006). The amount of negative emotions associated with hassles has been found as the best predictor of resulting stress, which can be determined by these factors (McIntyre et al., 2008).

Interpersonal hassles

Many researchers have emphasised the role for ‘interpersonal hassles’ being the strongest contributor to perceived stress. These can include interpersonal events (time spent with family, sex, intimacy, family related-obligations), and individuals or groups (problems with children, spouse, fellow workers; Maybery and Graham, 2001). It has been found that interpersonal hassles are the strongest predictors of personal distress and negative mood outcomes (Maybery and Graham, 2001). This means that experiencing more frequent interpersonal hassles would result in negative mood states, possibly eventuating into stress.

Accumulation effect

It is posed that the accumulation of persistent hassles in life can build up to become an ongoing state of stress and irritation (Kanner et al., 1981). Each hassle on its own may not be perceived as stressful, but the sum of the whole leads to ongoing feelings of stress.

Amplification effect

Facing current states of chronic stress and demands in life may amplify the impact of hassles have. Kanner et al., (1981) outlines that major life events which are stressful could in turn affect a person’s pattern of daily hassles. An example being going through a divorce could result in a collection of residual and unusual minor demands such as having to learn to cook for one, changing finance arrangements, and taking on household chores alone. Changes in routine as a result of chronic periods of stress can be perceived as ongoing hassles, amplifying how stressful hassles seem.

As the transfer of hassles proceeds into a stressful experience, there becomes taxing demands on the body to cope with stress.

When hassles become stress

Hassles have a strong influence on the experience of stress and the subsequent general and mental health outcomes (Chamberlin, 1990). Aside from the psychological discomfort of being stressed, stress can have renowned physiological effects on the body. Stress sets in a series of defence mechanisms throughout the body which try and restore a state of normality (Miller and O’Callaghan, 2002). When these defence or ‘fight back’ mechanisms are on overdrive for long periods of time, this depletes the body’s vital resources. This can produce lifelong patterns of a ‘stress’ activation in the body, which is argued to lead to the later negative related health outcomes (Vasiliadis, Forget, and Preville, 2012).

• General health

Stress affects cardiovascular health

The outcomes of long-lasting stress are linked to the current six most common causes of deaths; heart disease, accidents, cancer, liver diseases, lung diseases, and suicide (Crum, Salovey, and Achor, 2013). It is associated with hypertension (Zimmerman and Frohlich, 1990) and hospitilisation rates (Crum et al., 2013). Hassles have also been linked to the onset and persistence of daily headaches (Benedittis, Lorenzetti and Fieri, 1990; Sorbi Maassen and Spierings, 2010) and chronic back pain (Vachon-Presseau et al., 2013). There is also a role for hassles for negative eating patterns by triggering the consumption of more pleasurable, high fat and/or sugar content foods to ‘cope’(O'Connor et al., 2008). It is also found that those who are at an normal, over weight, or upper weight range are generally more susceptible to gain more weight when stressed (O'Connor et al., 2010).

• Mental health

There is a support for a diathesis-stress modal for most mental illnesses, in that genetic and psychological vulnerabilities for mental illness, when combined with the presence of stressful states, can trigger the onset of the mental illness (Pattern, 2013). It has been found that daily hassles are linked to anxiety disorders (Vasiliadis et al., 2012). Persistent and elevated levels of stress contributes to the distressing physiological effects of anxiety, such as tightness in the chest, and feelings of being on edge to name a few (Vasiliadis et al., 2012). Accumulation of daily hassles are also associated with depression (Vasiliadis et al., 2012), suicidal ideation (Kraaij V, Arensman E, Spinhoven, 2002), and schizophrenia (Lee, 2002).

The daily uplifts on emotion

It may be obvious that having a positive experience would lead to positive emotions. Experiencing an uplift has been associated with higher levels of positive mood (Stone, 1987), are seen to predict positive affect, contribute to general feelings of happiness, joy, and optimism (Kanner et al., 1981).

However, the role of uplifts on emotion does not quite match the influence that hassles have for stress and negative moods (Wolf, Elston and Kissling, 1989). One study showed that uplifts were in fact unrelated to mood, while daily hassles was a better predictor of concurrent negative moods than the majorly stressful life events (such as divorce, graduating, moving houses; Wolf et al., 1989). This has also been found on a review study (Chamberlin, 1990), which suggests a small effect for uplifts to in fact ‘uplift’ our mood. This finding may not negate the overall theory that Delongis et al., (1980) proposed, but may reflect a general biases in thinking to underestimate and overlook the uplifts we experience in our day to day. It would be useful to investigate whether drawing attention on the uplifts in our day could help dissipate the stressful effects of hassles more to support this theory.

Daily uplifts and hassles in tandem

Is there really a balance between uplifts and hassles?

It was originally proposed that positive experiences and positive emotions we gain from experiencing an uplift play a role in how we cope with stress. Lazarus et al., (1980) had suggested that these may act as ‘breathers’ from stressful encounters, ‘restorers’ of depleted resources lost in the body when dealing with stress, and ‘sustainers’ of coping. However, research is mixed on this proposed theory. Some find hassles and uplifts do not significantly interact with each other (Charles et al., 2010), while others do find a relationship (Finan et al., 2010). Early evidence did support this theory through findings for a stability of the experiences of minor events.

Stability for hassles and uplifts?

The first to empirically test this relationship was Kanner et al., (1981) in a heuristic study showing the stability of hassles and uplifts. It was found in this experiment that the experience of daily hassles and uplifts were positively related to each other over 9 months. It was suggested that this relationship may reflect either a tendency in some people to experience both as many hassles as uplifts, or a general response style to judge hassles and uplifts in relative intensity (Kanner et al., 1980). A review on this research supports a stable pattern between hassles and uplifts, so if an individual perceived more hassles they may be left in a state of stress, and the opposite for uplifts (Chamberlin, 1990).

However, this early research has been criticised. In Kanner et al.,’s (1980) experiment, the amount of distress or pleasure associated with experienced hassles or uplifts varied more than the number of events, showing a more indirect link from these minor experiences on emotion (Erlandsson, 2008). Erlandsson (2008) expanded on this finding, showing that if minor stressors are assessed in their means of intensity on emotion, this stability is lowered. This may suggest overall that there is fluctuation in the amount of emotion associated with hassles and uplifts, even when the number of events experienced remains stable. In all, the proposed 'balance' may not be relevant.

So are they in balance?
While it was proposed that uplifts may buffer the stress brought on by hassles by providing a means for positive emotion, this has not been sustained in research. There seems to be a strong influence for hassles on our emotional experiences of stress and negative moods, while uplifts have only been found to have a minor role to uplift our moods.

Avoiding stress and living happy

As hassles are imperative and apart of life, it comes important to combat ongoing feelings of irritation so stress does not set in. It is also important to attain the full benefits of experiencing an uplift to enhance the proposed role this ‘buffer’ may have for hassles.

Don't worry

If stress is to be avoided Wolfe et al., (1989) suggests trying to mitigate negative emotions that hang around from hassles. Interventions aimed at alleviating stress should address the emotional consequences of hassles. This could be done by altering the perception of negative emotions through learning relaxation, resilience, and seeking social support.

Relaxation –

Tavousi, (2008) found in an experiment that the experience of daily hassles can be perceived as less impactful after engaging in progressive muscle relaxation training. This relaxation technique involves tensing up muscles/ muscle groups in the body for set time period (possibly 20 seconds), and eventually releasing this tension (Tavousi, 2008). When releasing the tension, attention is directed on the difference between the tightened muscles and the relaxed muscles to produce a relaxed state and a feeling of 'letting go' (Tavousi, 2008). One would work through different muscles in the body, starting at the toes and working up towards the face through each session. One would do relaxation sessions in a dark, quiet room, with minimal distractions (Tavousi, 2008).

For more on this and other relaxation techniques visit Beyond Blue - relaxation techniques

Social Support -

Our loved ones can help us through times of stress

Seeking the support of close ones in individual’s lives can help provide the emotional support necessary to deal with the irritations of experiencing hassles. Family members, partners, and friends, can all play roles in providing emotional support by providing an individual with a chance to talk about the problems one is facing (Lim, Hepworth and Bogossian, 2011). By seeking feedback and advice on the problem, others can provide better, and more creative, solutions for how to react to hassles (Lim et al., 2011). Comfort can be gained by sharing the ordeals of hassles to as others provide sympathy, understanding, and moral reasoning (Lim et al., 2011). If we are feeling the brutes of a negative mood after a hassle filled day, it can be useful to confide in a friend or close one in our lives to help alleviate our resulting irritated (or possibly stressful) moods.

Resilience –

Being resilient does not constitute being indestructible, but being able to deal with life events and meet problems as opportunities for personal growth (Tempski, 2012). It also means being able to organise strategies in the face of hardship through self-reflection, creativity, optimism, humour, being flexible (Tempski, 2012). It is proposed that we can learn resilience by engaging in such thinking strategies. We can self-reflect on our thoughts and behaviours that arise in response to a hassling situation. We can derive creative solutions to dealing with the hassle by thinking ‘outside the box’. We can do this by attaching a humour to the hassle, or thinking more optimistically about the situation. By practicing this, resilience can be built and limit the emotional reactivity we have to hassles.

Be Happy

Other self-enhancing strategies can ensure daily uplifts can more strongly impact a positive mood. Savouring the moment, and practicing gratitude, can guide our perception of uplifts to be more positive and hopefully attain that ‘buffer’ that has been proposed by researchers.

Savouring the moment –

Savour brilliances that come into your life

Savouring is a propensity to focus on and enjoy past, current and future events through three processes (Hurley and Kwon, 2012).

• Anticipation – enjoying the positive emotions from contemplating the future.

• Reminiscing – appreciating positive emotions that occurred from past experiences.

• Savouring the moment – appreciating positive emotions during the present moment of a positive event.

Savouring our ‘minor’ uplifts can prolong the ‘happy’ emotions felt, create higher levels of self-esteem, and create feelings of optimism (Hurley and Kwon, 2012). One can effectively ‘savour’ an uplift by focusing attention on the present moments during an uplift, focusing on the feelings experienced, engaging in positive rumination (going over the positive feelings after the event in ones mind), and sharing with others positive experiences. This can create higher levels of satisfaction in life and is shown to override the negative emotions associated with daily hassles (Hurley and Kwon, 2012).

Gratitude –

Gratitude is a feeling that occurs when one acknowledges the receiving of a personal benefit that was not intentionally sought after, deserved, or earned (Emmons, 2013). When an individual affirms the ‘good things’ in one’s life, and recognises the sources of the ‘goodness’ that occurred partially outside of one’s control (such as receiving a gift from another person, or a random act of kindness), this can create feelings of gratefulness (Emmons, 2013). It has been proposed that experiencing a feeling of gratefulness can have therapeutic effects. These healing effects arise when we feel affirmed, esteemed, and strengthened to do more and better in life (Emmons, 2013). To elaborate the positive emotions experienced during an uplift, one can practice gratitude for the event by reflecting on the somewhat undeserved goodness that has resulted. Click here for more on gratitude

Do It Yourself Conclusion

What did you learn from the study of hassles and uplifts?

Point added for a correct answer:
Points for an incorrect answer:
Ignore the questions' coefficients:

1 Daily hassles are....

	Ongoing, disruptive, and irritating strains of life. Hassles can take form in practical nuisances, unexpected occurrences, and interpersonal problems.
	Any situation that makes us irritated or stressed.

2 Uplifts are...

	The minor pleasures we gain from experiencing a positive event
	The feeling we get when we are happy and positive.

3 Daily hassles can shift to stress due to

	Amplification of hassles in the face of other stressful events, accumulation of hassles, personality differences and the presence of interpersonal problems
	When an individual perceives a hassle as stressful.

4 The associated emotions with uplifts VS hassles are:

	happiness, satisfaction, good mood VS stress alone.
	satisfaction, positive affect, optimism VS irritation, frustration, negative and pervasive moods, depression and stress.

5 The final viewpoint on the relationship between hassles and uplifts best represents:

	They share a relationship and balance out each other equally - if we experience more hassles we would be left feeling irritated or stressed, or if we experienced more uplifts we would be experiencing more positive emotions.
	The relationship is weak. The uplifts we encounter have only a small influence on our emotions and mood states. It is the hassles we endure that leave the biggest ‘mark’ on our emotional functioning as stress takes over.

6 What is the thinking behind using stress-reduction coping skills and self-enhancing skills in managing uplifts and hassles?

	As hassles have the strongest influence on our emotions, it is important to mitigate the emotional disturbance that resides after experiencing hassles or feeling stressed. While uplifts do not have such a strong influence, it is important to heighten the proposed 'buffering' role it can have by practicing self-enhancing strategies.
	We need to control stress by distracting ourselves from the problems and ignoring our emotions. We practice self-enhancing strategies to feel better but this does not influence our emotions as uplifts only have a minor influence on us.

See also

• Stress Reduction
• Optimism
• Transactional Model Of Stress And Coping
• Joy
• Coping psychology

References

Benedittis, G. D., Lorenzetti, A. & Fieri, A. (1990). The role of stressful life events in the onset of chronic primary headache. Pain, 40(1), 65-75.doi.org/10.1016/0304-3959(90)91052

Campbell-Sills, L., Cohan, S. L., & Stein, M. B. (2006). Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behaviour Research And Therapy, 44(4), 585-599. doi: org/10.1016/j.brat.2005.05.001

Chamberlain, K. (1990). The minor events approach to stress: Support for the use of daily hassles. British Journal Of Psychology, 81(4), 469.

Charles, S. T., Luong, G., Almeida, D. M., Ryff, C., Sturm, M., & Love, G. ( 2010). Fewer ups and downs: Daily stressors mediate age differences in negative affect. Journal of Gerontology: Series B: Psychological Sciences, 65, 279– 286. doi: 10.1093/geronb/gbq002

Crum, A. J., Salovey, P., & Achor, S. (2013). Rethinking stress: The role of mindsets in determining the stress response. Journal of Personality and Social Psychology, 104, 716-733. doi:10.1037/a0031201

DeLongis, A., Coyne, J. C., Dakof, G., Folkman, S. & Lazarus, R. S. (1982). Relationship of daily hassles, uplifts, and major life events to health status. Health Psychology, 1(2), 119-136.

Erlandsson, L. (2008). Stability in women's experiences of hassles and uplifts: A five-year follow-up survey. Scandinavian Journal Of Occupational Therapy, 15(2), 95-104. doi:10.1080/11038120701560467

Emmons, R. (2013). Gratitude as a Psychotherapeutic Intervention. Journal Of Clinical Psychology, 69(8), 846-855.

Fontaine, R. K., Manstead, A. S. R., Wagner, H. (1993). Optimism, perceived control over stress, and coping. European Journal Of Personality, 7(4), 267-281. doi: 10.1002/per.2410070407

Florian, V., Mikulincer, M., & Taubman, O. (1995). Does hardiness contribute to mental health during a stressful real-life situation? the roles of appraisal and coping. Journal Of Personality And Social Psychology, 68(4), 687-695. doi:10.1037/0022-3514.68.4.687

Glenn, A., Tennen, H., Urrows, S., & Higgins, P. (1994). Person and contextual features of daily stress reactivity: individual differences in relations of undersireable daily events with mood disturbances and chronic pain intensity. Journal Of Personality And Social Psychology, 66(2), 329-340. doi:10.1037/0022-3514.66.2.329

Hurley, D. B., & Kwon, P. (2012). Savouring helps most when you have a little: interaction between savouring the moment and uplifts on positive affect and satisfaction with life. Journal Of Happiness Studies, 14, 1261-1271. doi: 10.1007/s10902-012-9377-8

Kraaij V, Arensman E, Spinhoven P. (2002). Negative life events and depression in elderly persons: a meta-analysis. Journal of Gerontology, 57, 87–94.

Kanner, A. D., Coyne, J. C., Schaefer, C. & Lazarus, R S. (1981). Comparison of two models of stress measurement: daily hassles and uplifts versus major life events. Journal Of Behavioral Medicine, 4 (1), pp 1-37. Retrieved from http://webs.wofford.edu/boppkl/courseFiles/Psy150/Labs/SocialLab/Kanner81_Hassles%20and%20Uplifts.pdf

Lazarus, R. S., Cohen, J. B., Folkman, S., Kanner, A. & Schaefer, C. (1980). Psychological stress and adaptation: some unresolved issues. In Selye, H. (Ed), Selye’s Guide To Stress Research. Van Nostrand Reinhold, NY, pp 90-117.

Lazarus, R. S. (1986). Puzzles in the study of daily hassles. Development As action In Context, 1, 39-53. Retrieved from http://link.springer.com/chapter/10.1007/978-3-662-02475-1_3

Lee, H. (2007). Protective and risk factors in adolescents with schizophrenia. Dissertation Abstracts International, 68.

Lim, J., Hepworth, J., & Bogossian, F. (2011). A qualitative analysis of stress, uplifts and coping in the personal and professional lives of Singaporean nurses. Journal Of Advanced Nursing, 67(5), 1022-1033. doi:10.1111/j.1365-2648.2010.05572.x

Maybery, D. J., & Graham, D. (2001). Hassles and uplifts: including interpersonal events.Stress And Health 17(2), 91-104. doi/10.1002/smi.891

McIntyre, K. P., Korn, J. H. & Matsuo, H. (2007). Sweating the small stuff: how different types of hassles result in the experience of stress. Stress And Health, 24, pp383-392. doi: 10.1002/smi.1190

Miller, D. B., & O’Callaghan, J. O. (2002). Neuroendocrine aspects of the stress response. Metabolism, 51(6B), 5-10. doi:10.1053/meta.2002.33184

O’Connor, D. B., Jones, F., Connor, M., McMillan, M. & Eammon, B. F. (2008). Effects of daily hassles and eating style on behaviour. Health Psychology, 27(1), 20-31. doi: 10.1037/0278-6133.27.1.S20

Patten, S. B. (2013). Major depression epidemiology from a diathesis-stress conceptualization. BMC Psychiatry, 13(1), 1-9. doi:10.1186/1471-244X-13-19

Rowden, P., Matthews, G., Watson, B., & Biggs, H. (2011). The relative impact of work-related stress, life stress and driving environment stress on driving outcomes. Accident Analysis And Prevention, 43(4), 1332-1340. doi:10.1016/j.aap.2011.02.004

Salvatore, M, R. (2005). On hardiness and other pathways to resilience. American Psychologist, 60(3), 261-262. doi: 10.1037/0003-066X.60.3.261

Sorbi, M J., Maassen, G. H. & Spierings, E. L. (2010). A time series analysis of daily hassles and mood changes in the 3 days before the migraine attack. Behavioural Medicine, 22(3), pp 103-113. doi10.1080/08964289.1996.9933771

Stone, A. A. (1987). Event content in a daily survey is differentially associated with concurrent mood. Journal of Personality and Social Psychology, 51, 56–58.

Tavousi, M. (2008). The effect of progressive relaxation training on stress management due to daily life events. Journal Of Iranian Psychologists, 4(16), 321-332.

Tempski, P. (2012). Teaching and learning resilience: a new agenda in medical education. Medical Education, 46(4), 345-346.

Totenhagen C, Serido J, Curran M, Butler E. (2012). Daily hassles and uplifts: a diary study on understanding relationship quality. Journal Of Family Psychology, 26(5):719-728.

Vachon-Presseau, E., Martel, M., Roy, M., Caron, E., Albouy, G., Marin, M., & Rainville, P. (2013). Acute stress contributes to individual differences in pain and pain-related brain activity in healthy and chronic pain patients. The Journal Of Neuroscience, 33(16), 6826-6833.

Vasiliadis, H. M., Forget, H., & Preville, M. (2012). The association between self-reported daily hassles and cortisol levels in depression and anxiety in community living older adults. Journal Of Geriatric Psychiatry, 28(10), 991-997. doi: 10.1002/gps.3912

Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychological Review, 96(2), 234-254. doi: 10.1037/0033-295X.96.2.234

Wolf, T. M., Elston, R. C., & Kissling, G. E. (1989). Relationship of hassles, uplifts, and life events to psychological well-being of freshman medical students. Behavioral Medicine, 15(1), 37-45. doi:10.1080/08964289.1989.9935150

Zimmerman, R. S., & Frohlich, E. D. (1990). Stress and hypertension. Journal Of Hypertension Supplement, 8(4), 103-107. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2258776