Haemodynamic reactions to acute psychological stress and smoking status in a large community sample

Exaggerated haemodynamic reactions to acute psychological stress have been implicated in a number of adverse health outcomes. This study examined, in a large community sample, the cross-sectional associations between haemodynamic reactivity and self-reported smoking status. Blood pressure and heart rate were measured at rest and in response to a 3-minute arithmetic stress task. Participants were classified as current, ex-, or non-smokers by their response to a simple prompt. Smokers had significantly smaller SBP and DBP reactions to acute stress than ex- and non-smokers; current and ex-smokers had lower HR reactivity. These effects remained significant following adjustment for a host of variables likely to be associated with reactivity and/or smoking. Although the act of smoking acutely increases haemodynamic activity, the present findings contribute to a growing body of literature showing that smokers have blunted reactivity to mental stress. They also support the hypothesis that blunted reactivity may be characteristic of a range of dependencies. The present results also suggest that smoking status needs to be considered in the design and analysis of stress reactivity studies.     

Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample

Exaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective.     

Type D personality is associated with low cardiovascular reactivity to acute mental stress in heart failure patients

Background

The distressed (Type D) personality is associated with adverse coronary heart disease outcomes, but the mechanisms accounting for this association remain to be elucidated. We examined whether myocardial and hemodynamic responses to mental stress are disrupted in Type D patients with chronic heart failure (HF).

Methods

Ninety-nine HF patients (mean age 65 ± 12 years; 75% men) underwent a public speech task, during which heart rate (HR) and blood pressure (BP) were recorded. Type D personality and its components negative affectivity (NA) and social inhibition (SI) were assessed with the DS14. General linear models with repeated measures and logistic regression were used to assess differences in stress response and recovery.

Results

Type D personality was associated with a reduced HR response (F_1,93 = 4.31, p < .05) independent of the use of beta adrenergic blocking agents and the presence of atrial fibrillation. There were no differences between HF patients with and without a Type D personality with respect to the BP response. Examining continuous NA and SI scores and their interaction (NA ∗ SI), revealed a significant association of NA ∗ SI with the SBP response (F_1,93 = 4.11, p < .05), independent of BP covariates. Results with respect to HR and DBP responses were comparable to the findings using the dichotomous Type D measure. No significant associations between Type D and recovery patterns were found.

Conclusion

HF patients with Type D personality may show an inadequate response to acute social stress, characterized by a blunted HR response.     

Self-reported health and cardiovascular reactions to psychological stress in a large community sample: Cross-sectional and prospective associations

Exaggerated cardiovascular reactions to acute psychological stress have been implicated in a number of adverse health outcomes. This study examined, in a large community sample, the cross-sectional and prospective associations between reactivity and self-reported health. Blood pressure and heart rate were measured at rest and in response to an arithmetic stress task. Self-reported health was assessed concurrently and 5 years later. In cross-sectional analyses, those with excellent/good self-reported health exhibited larger cardiovascular reactions than those with fair/poor subjective health. In prospective analyses, participants who had larger cardiovascular reactions to stress were more likely to report excellent/good health 5 years later, taking into account their reported health status at the earlier assessment. The findings suggest that greater cardiovascular reactivity may not always be associated with negative health outcomes.     

Blunted cardiac reactions to acute psychological stress predict symptoms of depression five years later: Evidence from a large community study

We recently reported a cross‐sectional negative relationship between cardiovascular reactivity and depressive symptoms. The present analyses examined the prospective association between reactivity and symptoms of depression 5 years later. At the earlier time point, depressive symptoms, measured using the Hospital Anxiety and Depression Scale (HADS), and cardiovascular reactions to a standard mental stress were measured in 1,608 adults comprising three distinct age cohorts: 24‐, 44‐, and 63‐year‐olds. Depression was reassessed using the HADS 5 years later. Heart rate reactions to acute psychological stress were negatively associated with subsequent depressive symptoms; the lower the reactivity the higher the depression scores. This association withstood adjustment for symptom scores at the earlier time point and for sociodemographic factors and medication status. The mechanisms underlying this prospective relationship remain to be determined.     

Blunted cardiovascular and cortisol reactivity to acute psychological stress: A summary of results from the Dutch Famine Birth Cohort Study

The Dutch Famine Birth Cohort Study is a large population based study of late middle aged, overall healthy men and women whose health has been followed from 50 to 65 years of age. In a sample of 725 cohort members, an extensive psychological stress protocol was performed during which cardiovascular and cortisol responses were measured. In line with many previous studies, results showed that increased blood pressure responsiveness to the stress protocol was associated with an increased risk for hypertension 5 years later. However, decreased cardiovascular and/or cortisol stress reactivity were associated with obesity and the risk of becoming obese, symptoms of depression and anxiety, a poor self-reported health, poor lung function, and poor cognitive function (all p for statistical tests < 0.05). These associations generally survived adjustment for a range of potential confounders, including resting cardiovascular and cortisol activity, commitment to the stress tasks, sex, age, smoking and use of medication. Results from these studies agree with recent evidence that low biological reactivity to acute psychological stress may not always be beneficial for health but instead seems to be a marker for a range of negative health outcomes. Future studies have to point out whether low stress reactivity precedes or follows these negative health outcomes.     

Aerobic exercise training and cardiovascular reactivity to psychological stress in sedentary young normotensive men and women

Forty-five (22 women) sedentary young (18-30 years old) nonsmoking normotensive volunteers engaged in either 6 weeks of aerobic training (AT), weight training (WT), or a no-treatment (NT) condition to determine whether AT lowers systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), and rate-pressure product (RPP) during rest, psychological stress, and recovery periods. Estimated VO(2)max increased for the AT (32.1+/-1.1 to 38.4+/-1.0 ml.kg(-1).min(-1)). A smaller increase for the WT (30.5+/-1.1 to 33.8+/-1.0) was likely due to increased leg strength, and VO(2)max did not change for the NT (32.5+/-1.1 to 32.9+/-1.0). Heart rate and RPP levels were lower during psychological stress and recovery after training for AT relative to the WT and NT. Overall SBP was also lower in the AT relative to the NT but not the WT. In conclusion, aerobic training lowered cardiovascular activity levels during psychological stress and recovery in healthy young adults, implying a protective role against age-related increases in coronary heart disease for individuals who adopt aerobic exercise early in life and maintain the behavior across the life span.     

Symptoms of depression and cardiovascular reactions to acute psychological stress: evidence from a population study

Depression and exaggerated cardiovascular reactivity are considered risk factors for cardiovascular disease, possibly as a result of common antecedents, such as altered autonomic nervous system function. We examined the association between depressive symptomatology and cardiovascular reactions to psychological stress in 1608 adults (875 women) comprising 3 distinct age cohorts: 24-, 44-, and 63-year olds. Depression was assessed using the Hospital Anxiety and Depression Scale. Blood pressure and heart rate were measured at baseline and during the paced auditory serial arithmetic test. Depression scores were negatively associated with systolic blood pressure and heart rate reactions, after adjustment for likely confounders such as sex, cohort, occupational status, body mass index, stress task performance score, baseline cardiovascular activity, antidepressant, and antihypertensive medication. The direction of association was opposite to that which would be expected if excessive reactivity were to mediate the association between depression and cardiovascular disease outcomes or if they shared common antecedents.     

Heart rate reactivity is associated with future cognitive ability and cognitive change in a large community sample

The relationship between cardiovascular reactions to acute mental challenge in the laboratory and cognitive ability has received scant attention. The present study examined the association between reactivity and future cognitive ability. Heart rate and blood pressure reactions to a mental stress task were measured in 1647 participants comprising three distinct age cohorts. Cognitive ability was assessed using the Alice Heim-4 test of general intelligence and choice reaction time 5 and 12 years later. High heart rate reactivity was related to higher general intelligence scores and faster choice reaction times at both follow-ups. High heart rate reactivity was also associated with a smaller decline in cognitive ability between assessments. These associations were still evident following adjustment for a wide range of potentially confounding variables. The present results are consistent with the notion that high reactivity may not always be a maladaptive response and that low or blunted reactivity may also have negative corollaries.     

Cardiovascular Reactivity to Psychological Stress in Healthy Children

Cardiovascular reactivity to stress has been implicated as a marker and/or mechanism in the development of cardiovascular disease. No normative data exist to classify children's reactivity to psychological stress. This investigation presents normative percentile data on the hemodynamic responses (heart rate and blood pressure) of 310 healthy, black or white, children between the ages of 6 and 18 years to the stress of a television video game. A series of three video games, played under three increasing levels of stress, elicited progressively higher values of blood pressure and heart rate. Both the child's race and gender, as well as the experimenter's race, significantly affected reactivity. Children demonstrated a wide range of interchild reactivity, thus allowing separation of individuals into high and low risk percentile groups.     

Metabolically exaggerated cardiac reactions to acute psychological stress revisited

The reactivity hypothesis postulates that large magnitude cardiovascular reactions to psychological stress contribute to the development of pathology. A key but little tested assumption is that such reactions are metabolically exaggerated. Cardiac activity, using Doppler echocardiography, and oxygen consumption, using mass spectrometry, were measured at rest and during and after a mental stress task and during graded submaximal cycling exercise. Cardiac activity and oxygen consumption showed the expected orderly association during exercise. However, during stress, large increases in cardiac activity were observed in the context of modest rises in energy expenditure; observed cardiac activity during stress substantially exceeded that predicted on the basis of contemporary levels of oxygen consumption. Thus, psychological stress can provoke increases in cardiac activity difficult to account for in terms of the metabolic demands of the stress task.     

High perceived stress in relation to life events is associated with blunted cardiac reactivity

The current study examined whether the perception of life stress related to cardiovascular reactivity. Participants (n = 100) completed the Perceived Stress Scale, the Undergraduate Stress Questionnaire, and undertook a standard mental arithmetic stress task. Blood pressure and pulse rate were measured at baseline, during, and following stress task exposure. Reactivity was the difference between stress and baseline cardiovascular activity. A perceived stress difference score (PSDS) was calculated by subtracting the Undergraduate Stress Questionnaire scores from the Perceived Stress Scale scores. Two groups were created: high PSDS (n = 15; PSDS at least 1 SD above the mean) and low PSDS (n = 15; PSDS at least 1 SD below the mean). There was a significant difference between groups in pulse rate reactivity, F(1,28) = 8.73, p = .006, η² = .24. High PSDS scores were associated with significantly lower pulse rate reactions to stress. Those who perceived their lives as more stressful than their actual stress exposures justified would appear to be characterised by blunted cardiac reactivity.     

Cardiac vagal activity during psychological stress varies with social functioning in older women

The polyvagal theory states that social behavior is linked to cardiac vagal control. This theory has been tested widely in infants and children, but less so in adults. Thus, we examined if resting or stress-related changes in high-frequency heart rate variability (HF-HRV; a presumed index of vagal control) varied with social functioning in 50 healthy women (mean age 68 years). After completing assessments of social functioning, women were exposed to laboratory stressors with concurrent psychophysiological monitoring. Although stressor-induced suppression of HF-HRV was common, women with less stressor-induced suppression of HF-HRV reported more positive social functioning. Resting HF-HRV was not related to social functioning. These findings are at apparent odds with the polyvagal theory; however, they complement prior work suggesting that emotional self-regulation could plausibly modulate cardiac vagal control in association with social functioning.     

The effect of left dorsal and ventral ansa subclavian transection on cardiac changes during behavioral stress in dogs

Alterations in heart rate (HR), left ventricular systolic pressure (LVP), and maximum rate of left ventricular pressure development (LVdp/dt max) during a 13 day Sidman shock avoidance task were studied in 3 groups of four chronically prepared dogs. In one group of animals the left dorsal and ventral ansa subclavian nerves were transected between the stellate and the caudal cervical ganglia. The second group of dogs was a neurologically intact, experimental stress group, and the third group was a neurologically intact, nonstress control. The intact stress group demonstrated phasic increases in HR and LVdp/dt max during the avoidance period of each day as well as tonic increases in HR, LVP, and LVdp/dt max during the 13 days of the experiment. The nerve transection animals showed no evidence of consistent phasic increases in any of the parameters during the avoidance period. Tonic levels of LVP and LVdp/dt max in the transection group were not significantly different from controls, but tonic levels of HR remained elevated. These results suggest that the integrity of the left ansa subclavian nerves is necessary for stress induced change in LVP, LVdp/dt max, and phasic increases in HR during the avoidance period of each day. However, right cardiac sympathetic, vagal and/or afferent influences are apparently responsible for stress induced tonic changes in HR.     

Physiological stress responses in defensive individuals: Age and sex matter

The association between defensiveness and physiological responses to stress were evaluated in 81 healthy working men and 118 women, aged 20 to 64 years (M=41; SD=11.45). Participants underwent laboratory testing during which they were exposed to interpersonal stressors. Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and salivary cortisol were measured. Defensiveness was evaluated using the Marlowe‐Crowne Social Desirability Scale. In women, higher defensiveness was associated with greater BP and HR reactivity to stress (p<.05). In older men, lower defensiveness was associated with increased systolic BP reactivity to stress (p<.02), delayed HRV recovery (p<.02), and greater salivary cortisol levels (p<.02). In conclusion, greater defensiveness was associated with increased reactivity to stress in women whereas in older men, lower defensiveness was associated with elevated cardiovascular, autonomic, and endocrine responses to stress.     

A twin study of cardiac reactivity and its relationship to parental blood pressure

The cardiac reactivity of 40 monozygotic and 40 dizygotic pairs of young male twins was monitored during psychological challenge, as afforded by a video game. The observed pattern of variation could not be accounted for solely by environmental factors. In fact, a simple genetic model that implicated additive genetic effects, along with those stemming from individual environments, best fitted the data. In addition, cardiac reactions were substantially greater for subjects whose parents both had relatively elevated blood pressure. Overall, these data suggest individual differences in cardiac reactivity have a heritable component, and that high reactivity may be a precursor of elevated blood pressure.     

Reliable responses to a cardiovascular reactivity protocol: A replication study in a biracial female sample

This replication study was designed to examine the reliability of individual differences in cardiovascular responsivity to a standardized PC-based cognitive task protocol (Kamarck et al., 1992) in a female community sample. Thirty women, both black and white (ages 25–44 years), were administered the protocol twice with a 1-month retest interval using a mobile laboratory at a community-based testing site. Measures of heart rate and blood pressure reactivity were obtained comparing assessments taken at rest and during three protocol tasks. Preejection period, stroke volume, and total peripheral resistance changes were estimated using impedance cardiography assessments. As in previous studies with males, individual differences in heart rate and systolic and diastolic blood pressure responses to the protocol were highly reliable (.80 or greater) when data were aggregated across three tasks and two testing sessions. Reliability of cardiac contractility (preejection period) and stroke volume changes to these tasks exceeded .70. This reactivity assessment procedure has now produced reliable results in three studies and appears to be exportable across diverse samples and settings.     

Speaking from the heart: cardiovascular components of stress rating changes and the relative reactivity of physiological and psychological variables

The first part of the experiment compared the relative reactivity of various cardiovascular measurements and self-reported assessment of mental arithmetic, an active coping stress task. It was found that the self-reported stres rating was more responsive (student's t=9.4) than the physiological measurements. Among the cardiovascular indices, heart rate was the most responsive (student's t=6.5), followed by the interval between R-wave and the maximal systolic pressure (student's t=5.0). The second part of the study used a multiple regression to examine the cardiovascular components of change in stres rating following mental arithmetic. Both resting (psychophysiological trait varibles) and change under stress (psychophysiological state variables) were used to predict change in stress rating. Stress rating increase were associated with greater maximal systolic pressure rate of rise (finger dP/dt) at baseline and less heart rate increase during mental arithmetic, yielding a multiple r of 0.67. The dual autonomic nature of active coping stress response is discussed. The shortcomings of using a correlate of a correlate are noted.     

Parental Hypertension and Cardiovascular Response to Stress in Healthy Young Adults

One indicator of elevated risk for subsequent development of essential hypertension is the presence of the disorder in either or both parents. Exaggerated cardiovascular responsivity to stress has also been suggested as a possible precursor to hypertension. This study examined the relationship between parental hypertension and the heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP) levels of 103 healthy college-age men, during two resting conditions and stressful cold pressor and reaction time tasks. Sons of hypertensive parents (N = 25) showed higher HR and SBP than sons of normotensive parents (N = 78) during both rest and stress, but these differences were greatest during the stressful reaction time (RT) task. No reliable differences in DBP were seen. A subsample of 45 subjects, including 14 with hypertensive parents, were also monitored during a second stress, the cold pressor test; only trends toward HR or BP differences related to parental hypertension were seen for this stress, although HR and SBP differences during the RT task were still significant (p<.05) even in this smaller group. Since the incidence of high blood pressure is known to be greater among the offspring of hypertensive parents, these findings suggest that cardiovascular responses to certain types of stress (e.g., active coping tasks) may help predict future risk of hypertension.