Systolic blood pressure reactions to acute stress are associated with future hypertension status in the Dutch Famine Birth Cohort Study

Abstract

These analyses examined the association between blood pressure reactions to acute psychological stress and subsequent hypertension status in a substantial Dutch cohort. Blood pressure was recorded during a resting baseline and during three acute stress tasks, Stroop colour word, mirror tracing and speech. Five years later, diagnosed hypertension status was determined by questionnaire. Participants were 453 (237 women) members of the Dutch Famine Birth Cohort. In analysis adjusting for a number of potential confounders, systolic blood pressure reactivity was positively related to future hypertension. This was the case irrespective of whether reactivity was calculated as the peak or the average response to the stress tasks. The association was strongest for reactions to the speech and Stroop tasks. Diastolic blood pressure reactivity was not significantly associated with hypertension. The results provide support for the reactivity hypothesis.

Introduction

The reactivity hypothesis considers that exaggerated cardiovascular reactions to acute psychological stress play a role in the development of hypertension and other markers of cardiovascular disease (Light, 1981, Obrist, 1981). Supporting evidence comes from large scale observational studies that find positive associations between the magnitude of cardiovascular reactions to acute psychological stress and future blood pressure status (Carroll et al., 2011, Carroll et al., 2003, Carroll et al., 2001, Everson et al., 1996, Newman et al., 1999, Flaa et al., 2008, Markovitz et al., 1998, Matthews et al., 1993, Treiber et al., 1997, Tuomisto et al., 2005) markers of carotid atherosclerosis (Barnett et al., 1997, Everson et al., 1997, Lynch et al., 1998, Matthews et al., 1998) and left ventricular mass (Georgiades et al., 1997). The effect sizes are generally small (Chida and Steptoe, 2010), but the evidence is certainly consistent with the reactivity hypothesis.

In the present analyses of data from the Dutch Famine Birth Cohort Study (Roseboom et al., 2006), we re-visited the issue of the role of cardiovascular stress reactivity in cardiovascular pathology, by examining the relationship between blood pressure reactions to a battery of standard stress tasks and prospectively determined diagnosed hypertension. Hypertension is a disease that is multiply determined (Beevers and Macgregor, 1995); accordingly, the case for a role for stress reactivity in its aetiology is less likely to rest on the size of its association with hypertension, but more on the consistency of that association across different populations, genders, and ages (Carroll et al., 2011). Further, such is the richness of the current data set that it permits adjustment for a range of potential confounding variables, far more than previous studies. In addition, blood pressure was measured continuously during stress exposure, in contrast to most other prospective studies of reactivity and hypertension where it was measured intermittently.