Abstract
BackgroundHeightened blood pressure (BP) responses to mental stress predict raised BP levels over subsequent years, but evidence for associations with incident hypertension is limited, and the significance of inflammatory responses is uncertain.PurposeWe investigated the relationship between BP and plasma fibrinogen responses to stress and incident hypertension over an average 8-year follow-up.MethodParticipants were 636 men and women (mean age 59.1 years) from the Whitehall II epidemiological cohort with no history of cardiovascular disease and hypertension. They performed standardized behavioral tasks (color/word conflict and mirror tracing), and hypertension was defined by clinic measures and medication status.ResultsOf participants in the highest systolic BP reactivity tertile, 29.3 % became hypertensive over the follow-up period compared with 16.5 % of those in the lowest tertile, with an odds ratio of 2.02 (95 % CI 1.17–3.88, p = 0.012) after adjustment for age, sex, grade of employment, body mass index, smoking, alcohol consumption, physical activity, follow-up time, subjective stress response, perceived task difficulty, perceived task engagement, and baseline BP. Similar associations were observed for diastolic BP reactivity (odds ratio 2.05, 95 % CI 1.23–3.40, p = 0.006) and for impaired systolic BP post-stress recovery (odds ratio 2.06, 95 % CI 1.19–3.57, p = 0.010). Fibrinogen reactions to tasks also predicted future hypertension in women (odds ratio 2.64, 95 % CI 1.11–6.30, p = 0.029) but not men.ConclusionsThese data suggest that heightened cardiovascular and inflammatory reactivity to mental stress is associated with hypertension risk, and may be a mechanism through which psychosocial factors impact on the development of hypertension.
Highlights
The role of psychological stress in the etiology of hypertension has been investigated using two main approaches
Fibrinogen reactions to tasks predicted future hypertension in women but not men. These data suggest that heightened cardiovascular and inflammatory reactivity to mental stress is associated with hypertension risk, and may be a mechanism through which psychosocial factors impact on the development of hypertension
There were no significant differences between future hypertensives and the remainder in age at baseline, grade of employment, smoking, alcohol consumption, physical activity, or follow-up interval, but incident hypertension was more common among men (p = 0.006)
Summary
The role of psychological stress in the etiology of hypertension has been investigated using two main approaches. A number of longitudinal studies have demonstrated that heightened blood pressure (BP) reactivity to acute stress predicts increases in tonic BP levels over time [2]. The theory underlying these investigations is that individual differences in acute stress reactivity measured on a single occasion reflect the person’s habitual response to everyday stress, and that repeated episodes of cardiovascular activation will lead to fixed hypertension. Heightened blood pressure (BP) responses to mental stress predict raised BP levels over subsequent years, but evidence for associations with incident hypertension is limited, and the significance of inflammatory responses is uncertain. They performed standardized behavioral tasks (color/word conflict and mirror tracing), and hypertension was defined by clinic measures and medication status
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