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Coronary heart disease remains an important cause of morbidity and mortality. Much data support the view that social support is associated with coronary heart disease. Participants of the study "Men born in 1914," (414 men) were followed from a baseline measurement in 1982/83 until the end of 1996. At baseline, the men answered a questionnaire on social support and participated in a stressful test where their behavior was categorized as adaptive or maladaptive. This study examined whether social support had a prospective impact on the incidence of myocardial infarction and all-cause mortality when behavior in the stressful task was taken into consideration. The conclusion of the study was that unsatisfactory levels of social support is associated with an increased risk of incident myocardial infarction (HR 2.40, CI 1.36-4.25, p = .003) and premature death (HR 1.99, CI 1.32-3.00, p = .001) but only in men who had shown maladaptive behavior in the test.

Background and Purpose-Although hypertension is a major risk factor for stroke, many hypertensive persons remain healthy. The aim of the present study was to analyze whether adaptation in a stressful situation was associated with the incidence of stroke in hypertensive men. Methods-Two hundred thirty-eight hypertensive men were followed from baseline in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation to stress was studied with the serial Color-Word Test. In the Regression dimension, 4 patterns of adaptation could be distinguished according to mastering of the test. Successful mastering of the test was shown in stabilized patterns, increasing difficulty in cumulative patterns, fluctuating difficulty in dissociative patterns, and fluctuating difficulty that increased during testing in cumulative-dissociative patterns. The patterns were compared regarding stroke incidence. Results-Forty-three men experienced a stroke during follow-up. Stroke rates per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for men with cumulative patterns, 16.2 for men with dissociative patterns, and 31.2 for men with cumulative-dissociative patterns. Multivariate analysis, adjusted for relevant cerebrovascular risk factors, showed that the cumulative-dissociative pattern of the Regression dimension was associated with an increased risk of stroke during follow-up (relative risk 3.00, 95% CI 1.32 to 6.81). Conclusions-The specific behavior pattern, characterized by the greatest difficulties in managing the test, was associated with incidence of stroke in hypertensive men. One interpretation is that hypertensive men who chronically fail to find successful strategies in stressful situations are vulnerable to the damaging effects of stress and thereby at an increased risk of a future stroke. (Stroke. 2001;32:1712-1720.)Key Words: hypertension Ⅲ neuropsychological tests Ⅲ stress, psychological Ⅲ stroke S troke is associated with huge costs, both economically and in terms of human suffering. Hypertension has been acknowledged as the major risk factor for stroke. 1 The associated risk can be assumed to be modified by interaction with several other factors, because not all hypertensive individuals experience a stroke. 2 In the case of myocardial infarction, many research programs have been aimed at delineating the relationship between incidence, psychological stress, and personality. [3][4][5][6] The effects of stress and personality factors on stroke incidence have attracted far less interest.Studies have, however, reported associations between stress and stroke. 7 Severe psychological stress or lifethreatening events have been related to an increased risk of both nonhemorrhagic and hemorrhagic strokes. 8 -11 General difficulties in coping with stress, 12 as well as specific features See Editorial Comment, page 1718of the type A behavior personality, 13,14 have also shown associations with an increased risk of stroke.So far, it has not been studied to what extent psychological stress and its management m...

Evidence is found to support the hypothesis that hypertension, especially high DBP in late midlife, is associated with a decline in spatial performance of cognitive functions in elderly men.

One hundred and sixty-eight men who were participants in the study "Men born in 1914" had their blood pressure and cognitive function examined when they were 68 years old. They were then re-examined at the age of 81. Decline on five standardized cognitive tests at the age of 81 years was studied in relation to four levels of baseline blood pressure at the age of 68. Results from multivariate analyses suggested that blood pressure, when studied in conjunction with other factors related to cognitive function, contribute to a rather modest extent and not unambiguously to the variability in cognitive decline. When decline on each separate test had been combined into a composite measure, where equal weight had been given to memory, crystallized and fluid abilities, it was shown that hypertension stage 2 (SBP 160-179 mmHg or DBP 100-109 mmHg) was associated with greater levels of overall decline. Hypertension stage 3 (SBP > or =180 mmHg or DBP > or =110 mmHg), on the other hand, was associated with lower levels of overall decline. Depressive symptoms at follow-up had a negative effect on cognitive levels and were discussed as potential confounders of hypertension-related cerebral lesions.

The Serial Color Word Test was administered at baseline to 253 hypertensive men participating in the prospective cohort study of cardiovascular diseases "Men born in 1914" in Malmö, Sweden. This test of psychological adaptation to a stressful encounter was used to investigate whether susceptibility to stress moderates the risk of a cardiac event in association with hypertension. Adaptive behavior, as measured by test performance, can be categorized in two dimensions. The regression dimension refers to linear change of time spent in the test session whereas the variability dimension refers to nonlinear change. Both dimensions consist of four different patterns. At follow-up (mean time = 8.2 +/- 3.5 years), the risk of a cardiac event varied between men with different adaptive patterns. One pattern, the Cumulative-Dissociative pattern of the variability dimension, characterized by a discontinuous and fluctuating time-consumption, was associated to an almost three-fold risk of a cardiac event during follow-up (relative risk [RR], 2.99; 95% confidence interval [CI], 1.33 - 6.70, p = .010) after adjustment for medical-, socioeconomic-, and lifestyle-related factors. No association existed between adaptive patterns and overall mortality.

Hypertension and its consequences on cognition was analyzed using data from the study "Men born in 1914" in Malmö, Sweden, a prospective cohort study of cardiovascular disease. The baseline examinations took place in 1982/83 where 500 men participated in extensive medical and social examinations. A neuropsychological investigation was completed including five standardized cognitive tests. The specific purpose of the study was to investigate whether hypertension was associated with cognitive performance. By the use of multiple regression analyses, normal blood pressure and three stages of hypertension were analyzed in relation to test performance. Hypertension Stage 3 was associated with lower performance on tests measuring psychomotor speed and visuospatial memory, whereas hypertension Stage 1 was associated with higher performance on tests measuring verbal ability and constructional ability. The associations were unconfounded by clinical manifestations of atherosclerosis, history of stroke, depressive mood, and antihypertensive drug treatment.

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