High Stress Responsivity Predicts Later Blood Pressure Only in Combination With Positive Family History and High Life Stress

Abstract

Abstract-High cardiovascular responsivity to stressors has not consistently improved prediction of later blood pressure increases beyond the predictive effects of baseline pressure. Animal models suggest that genetic susceptibility to hypertension and frequent stress exposure are important modulating factors in stress-related hypertension. Thus in 103 men originally tested at age 18 to 22 years and reassessed 10 years later, interactive effects of genetic susceptibility (defined as 1 or more hypertensive parents) with high stress responsivity (defined as top 25% on the basis of blood pressure and cardiac responses during both reaction time and cold pressor tasks) were examined in relation to follow-up systolic and diastolic levels and to change in blood pressure status from normal (diastolicϽ80 mm Hg) to marginally elevated (diastolic 85 to 95 mm Hg). Men with the combination of high stress response and hypertensive parents demonstrated higher systolic (PϽ0.05) and diastolic levels (PϽ0.05) at follow-up, and they showed a 7-fold increase (7.5, 95% confidence intervals 2.3, 24.3; PϽ0.001) in relative risk of change in blood pressure status versus men with no family history and a 3-fold increase (3.8, confidence intervals 1.5, 9.6; PϽ0.004) versus less stress-responsive men who also had hypertensive parents. In 65 men who also provided ratings of daily stress, family historyϫstress responsivityϫdaily stress interactions were significant in predicting follow-up systolic and diastolic levels (PϽ0.006 and 0.03, respectively), with highest pressure levels seen when high life stress was reported by high stress responders and/or men with hypertensive parents. In conclusion, results suggest that stress responsivity as a long-term predictor is modulated by both genetic and environmental factors. (Hypertension. 1999;33:1458-1464.) Key Words: stress Ⅲ genes Ⅲ reactivity Ⅲ family history Ⅲ hypertension, essential T he issue of whether high cardiovascular responses to laboratory stressors in normotensive individuals may be predictive of later hypertension development is still unresolved. [1][2][3] The strongest support for this hypothesis derives from prospective research in which blood pressure and heart rate responses to 1 or more stressors were related to increased blood pressure (BP) at follow-up intervals ranging from 1 year to 28 years later. Hyperreactivity of systolic BP (SBP) to the cold pressor test was related to increased development of hypertension after an average of 24 and 28 years of followup. 4,5 High cardiovascular responses to active coping mental stressors have also predicted greater BP increases at followup. 6 -13 The largest of these latter studies was based on 3300 black and white young adults from the longitudinal CARDIA Investigation. 13 Their results were mixed, however, indicating that after 5 years of follow-up, high systolic reactivity to the active coping video game but not to the passive cold pressor was predictive of greater blood pressure rises and increased incidence of hypertension in men b...

Quantitative genetic analysis of blood pressure reactivity to orthostatic tilt using principal components analysis

“…9,10 One reason for these equivocal results is the fact that genetic factors are rarely accounted for in studies of BP reactivity. 11,12 A few studies have shown evidence for genes influencing BP changes in response to orthostasis (i.e., postural change), [13][14][15] but one aspect of this research that has been largely ignored is the identification of unique or shared genetic influences on different BP measures at rest and during orthostasis. In other words, do the same genes regulate BP both at rest and during orthostasis?…”

Impaired Natural Killer Cell Lysis in Breast Cancer Patients with High Levels of Psychological Stress is Associated with Altered Expression of Killer Immunoglobin-Like Receptors

“…The relationship between chronic stress and NK cytotoxicity has been well documented [15,33]. However, individuals vary in the degree of physiologic response to psychological stress [34][35]. Because this was an exploratory study, our goal was to examine only patients exhibiting a physiological response to stress.…”

The effects of exercise on haemodynamic function in relation to the familial hypertension risk model

“…Indeed, men with the combination of high stress responsivity and FH þ demonstrated higher blood pressure at a 10 year follow-up and a seven-fold increase in relative risk of change in blood pressure status compared to men without family history of hypertension (FHÀ) and low stress responsivity. 15 Regular exercise is associated with a lower incidence of hypertension, 16 although paradoxically, exercise may be viewed as potent stressor to the cardiovascular system. In FH þ the exercise pressor response appears to be exaggerated, 17,18 which is an independent predictor of future hypertension risk.…”