Blood pressure reactivity to mental stress task as a determinant of sustained hypertension after 5 years of follow-up

Abstract

Previous studies have reported an increased risk of developing sustained hypertension (SH) in borderline or mildly hypertensive subjects showing an exaggerated response of blood pressure (BP) to mental stress. The aim of this study was to assess if the response of BP to mental stress tasks is an independent predictor of SH. A total of 89 patients with grade 1 hypertension, aged 18-64 years, 62% males, were included. The mean of follow-up was 5.3 years (s.d. 2.1 years). SH was defined as the development of grades 2-3 hypertension (Systolic BPX160 mmHg or diastolic BPX100 mmHg) or to be in antihypertensive treatment after follow-up. Two mental stress tasks: mental arithmetic stress task and a stressful interview (SI) were applied at entry. The subjects were classified as hyper-reactors when BP increase was greater than 35 mmHg for systolic BP or greater than 21 mmHg for diastolic BP, according to the results obtained previously in a normotensive control group. In the univariate analysis, the factors associated with the development of SH were age (P ¼ 0.0007), office diastolic BP (P ¼ 0.014) and hyper-reactivity of BP during a stressful interview (P ¼ 0.003). In the Cox regression model, after adjusting for gender, age, and office BP, the hyper-reactivity of BP during SI was an independent predictor of development of SH. In conclusion, the response of BP to mental stress tasks is useful in predicting SH in young and middle-aged subjects with grade 1 hypertension.

Job Strain, Ethnicity, and Sympathetic Nervous System Activity

“…Within this study, individuals who reported high job strain had greater BP reactivity than did those in the nonhigh strain group. Because increased BP reactivity can be a risk factor for cardiovascular disease, 45,46 the current results provide further evidence that high job strain places individuals at risk for cardiovascular disease. 2,29,30 Secondary analyses were conducted to determine whether job strain moderated the relationship between ethnicity and pressor sensitivity.…”

Hemodynamic mechanisms of the attenuated blood pressure response to mental stress after a single bout of maximal dynamic exercise in healthy subjects

“…During mental stress, sympathetic nervous system activation and parasympathetic inhibition increase arterial pressure and heart rate, leading to increased myocardial oxygen consumption (1). Although this is a physiological phenomenon, exacerbated responses of blood pressure confer an increased risk of developing hypertension (2,3). Moreover, susceptible individuals may present a reduction of myocardial perfusion and increased electrical instability during stress, triggering acute myocardial infarction and cardiac arrhythmias (4,5).…”

“…Even when blood pressure does not decrease below pre-exercise values, the autonomic and hemodynamic functions remain altered for several minutes or hours after a single bout of exercise (7,11,16). Thus, it is not surprising that the blood pressure response to mental stress, which is of relevant prognostic value (2,3), is attenuated after a single bout of exercise (17-21). Since blood pressure is the result of the relationship between cardiac output and systemic vascular resistance, either vascular (peripheral) or cardiac (central) mechanisms could be responsible for the attenuation of the blood pressure response observed after an exercise bout, but these hemodynamic mechanisms have not been specifically studied.…”

Sex differences in the modulation of vasomotor sympathetic outflow during static handgrip exercise in healthy young humans

“…The hormone profile of premenopausal women suggests that estrogen and/or progesterone provide a degree of cardioprotection (27,39). BP reactivity has been described as one predictor of the future development of hypertension (1,8). Based on this, we would expect to see sex differences in BP responses to tests such as static handgrip exercise, which is one way to assess BP control through a pressor response.…”