Adaptive Behavior in Stressful Situations and Stroke Incidence in Hypertensive Men

Abstract

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...

Knowledge About Risk Factors for Stroke

“…20 -23 There are a number of reasons for this uncertainty regarding stress and other psychosocial factors. First, stress is an unclear concept for both researchers and patients, often used for different underlying situations or psychological states, for example, stress at work or at home, 20,21 With respect to coronary heart disease, a recently published case-control study by Rosengren et al 24 showed that stress was an independent major risk factor for myocardial infarction. Additional research should focus to clarify the role of stress as a risk factor in the etiology of stroke.…”

The Socioeconomic Gradient in the Incidence of Stroke

“…Psychosocial factors such as stress at work may also play a role because they are associated with cardiovascular disease, 16 stroke risk factors, 17 and socioeconomic status, 18 and men with poor adaptation to stress have an increased risk of stroke. 13,19 The aim of this study is to establish whether a socioeconomic gradient in stroke existed in a group of Swedish women, 20 and whether this gradient could be explained by established stroke risk factors or psychosocial factors using comprehensive assessment of risk factors and validated stroke outcome measures.…”

Self-Reported Stress and Risk of Stroke

“…6,8 In the present study, data from men and women participating in the Copenhagen City Heart Study (CCHS) on the intensity and frequency of self-reported stress have been analyzed for all strokes, nonfatal stroke, and fatal stroke. As part of the analyses, we have compared the risk factor profiles of the different stress groups.…”