Stress-Induced Blood Pressure Reactivity and Incident Stroke in Middle-Aged Men

Abstract

Background and Purpose-Exaggerated blood pressure reactivity to stress is associated with atherosclerosis and hypertension, which are known stroke risk factors, but its relation to stroke is unknown. Previous work also indicates that the association between reactivity and cardiovascular diseases may be influenced by socioeconomic status. Methods-The impact of blood pressure reactivity and socioeconomic status on incident stroke was examined in 2303 men (mean age, 52.8Ϯ5.1 years) from a population-based, longitudinal study of risk factors for ischemic heart disease in eastern Finland. Reactivity was calculated as the difference between blood pressure measured during the anticipatory phase of an exercise tolerance test (before exercise) and resting blood pressure, measured 1 week earlier. Mean systolic reactivity was 20 mm Hg (Ϯ15.9), and mean diastolic reactivity was 8.6 mm Hg (Ϯ8.5). Socioeconomic status was assessed as years of education. One hundred thirteen incident strokes (90 ischemic) occurred in 11.2 (Ϯ1.6) years of follow-up. Results-Men with exaggerated systolic reactivity (Ն20 mm Hg) had 72% greater risk of any stroke (relative hazard ratio[RH], 1.72; 95% CI, 1.17 to 2.54) and 87% greater risk of ischemic stroke (RH, 1.87; 95% CI, 1.20 to 2.89) relative to less reactive men. Moreover, men who were high reactors and poorly educated were nearly 3 times more likely to suffer a stroke than better educated, less reactive men (RH, 2.90; 95% CI, 1.66 to 5.08). Adjustment for stroke risk factors had little impact on these associations. Diastolic reactivity was unrelated to stroke risk. Conclusions-Excessive sympathetic reactivity to stress may be etiologically important in stroke, especially ischemic strokes, and low socioeconomic status confers added risk.

Heightened Functional Neural Activation to Psychological Stress Covaries With Exaggerated Blood Pressure Reactivity

“…36 Exaggerated blood pressure reactivity also predicts incident hypertension 4 and stroke. 5 Exaggerated blood pressure reactivity is thought to mediate the relationship among several environmental, genetic, and psychosocial factors and risk for cardiovascular disease. 3,37 Here, we provide novel evidence that heightened stressor-induced neural activation in a delimited set of brain systems is uniquely associated with exaggerated blood pressure reactivity.…”

“…2 Some individuals, however, have a tendency to show exaggerated rises in blood pressure that exceed the metabolic demands of psychological stressors. 3 Such exaggerated stressor-induced blood pressure reactions predict increased risk for hypertension, 4 stroke, 5 and preclinical atherosclerosis. 6,7 Blood pressure reactions to psychological stress are centrally controlled by brain systems that both cognitively process psychological stressors and coordinate autonomic, neuroendocrine, and cardiovascular activity with adaptive behavior.…”

Body size at birth and cardiovascular response to and recovery from mental stress in children

“…For example, men with exaggerated SBP response (420 mm Hg) had 72% higher risk of any stroke and 87% higher risk of ischaemic stroke compared with others. 7 Higher CV response to mental stress has also been associated with hypertension, 8 calcification in the coronary arteries 9 and increased left ventricular mass. 10 Atherosclerotic changes are evident already during childhood.…”

Changes in plasma lipids with psychosocial stress are related to hypertension status and the norepinephrine stress response

“…Sympathetic predominance is both a risk factor for developing sustained hypertension [2] and for developing cardiovascular disease (CVD) in those with sustained hypertension [3,4]. Markers of sympathetic activity such as norepinephrine (NE) levels are generally higher in hypertensives than normotensives, both at baseline and when confronted with a psychosocial stressor [5][6][7][8][9].…”