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.     

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.     

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.     

Cognitive ability and simple reaction time predict cardiac reactivity in the West of Scotland Twenty-07 Study

Few studies have examined the association between cognitive ability and cardiovascular reactivity, although both have been implicated in later cardiovascular disease. We studied the relationship between cognitive ability, assessed using the Alice Heim-4 test of general intelligence, simple reaction time, and subsequent cardiovascular reactivity in 409 55-year-olds. Blood pressure and heart rate reactions to an acute mental arithmetic task were measured 7 years after cognitive assessment. In regression models that adjusted for baseline cardiovascular activity, socio-demographics, body mass index, medication status, and stress task performance, cognitive ability and reaction time were associated with future cardiac reactivity. Low reactivity was characteristic of those with relatively low cognitive ability. The results are consistent with the notion that high reactivity may not always be a maladaptive response.     

Low forced expiratory volume is associated with blunted cardiac reactions to acute psychological stress in a community sample of middle-aged men and women

It has been argued recently that blunted cardiovascular reactions to acute psychological stress have adverse behavioural and health corollaries that reflect dysregulation of the neural systems that support motivation. We examined the association between cardiovascular reactions to a standard stress task, the paced auditory serial arithmetic rest, and forced expiratory volume in one second, an effort, hence motivation, dependent assessment of lung function measured by spirometry. Low forced expiratory volume, expressed as a ratio to height squared was associated with blunted heart rate, but not blood pressure, stress reactivity, r = .17, p < .001. The association survived adjustment for smoking, a range of anthropometric and sociodemographic covariates, resting heart rate and stress task performance, β = .11, p = .005. As such, our results provide support for the hypothesis that blunted stress reactivity may be a peripheral marker of a dysfunction in the brain systems that support motivated behaviour.     

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.     

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.     

Stressed out? Associations between perceived and physiological stress responses in adolescents: The TRAILS study

Studies regarding the interrelation of perceived and physiological stress indices have shown diverging results. Using a population sample of adolescents (N=715, 50.9% girls, mean age 16.11 years, SD=0.59), we tested three hypotheses: (1) perceived responses during social stress covary with concurrent physiological stress responses; (2) high pretest levels of perceived stress predict large physiological responses; and (3) large physiological responses to social stress predict low posttest perceived stress levels. Perceived arousal, unpleasantness, and dominance were related to heart rate, respiratory sinus arrhythmia, and cortisol responses to a laboratory social stress test. Although effect sizes were small, the results suggest covariation of perceived stress and concurrent physiological stress responses in both the ANS and the HPA axis, as well as inverse associations between heart rate responsiveness and the subsequent appraisal of stress.     

Integrative commentary: Implications of blunted reactivity

The previous issue of the International Journal of Psychophysiology was a special issue that collected some of the latest emerging evidence on blunted reactivity and its relationships with a variety of negative health outcomes. This commentary on the special issue briefly reviews each of the contributions and then provides some thoughts on the general themes that run through these papers. The findings from the special issue suggest that both lower and higher than expected cardiovascular and neuroendocrine responses to active psychological challenges may be maladaptive and differentially associated with adverse health sequelae.     

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.     

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.     

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.     

Cardiovascular reactivity in real life settings: Measurement, mechanisms and meaning

Cardiovascular reactivity to stress is most commonly studied in the laboratory. Laboratory stressors may have limited ecological validity due to the many constraints, operating in controlled environments. This paper will focus on paradigms that involve the measurement of cardiovascular reactions to stress in real life using ambulatory monitors. Probably the most commonly used paradigm in this field is to measure the response to a specific real life stressor, such as sitting an exam or public speaking. A more general approach has been to derive a measure of CV variability testing the hypothesis that more reactive participants will have more variable heart rate or blood pressure. Alternatively, self-reports of the participants’ perceived stress, emotion or demands may be linked to simultaneously collected ambulatory measures of cardiovascular parameters.This paper examines the following four questions: (1) What is the form and what are the determinants of stress-induced CV reactivity in real life? (2) What are the psychophysiological processes underlying heart rate and blood pressure reactivity in real life? (3) Does CV reactivity determined in the laboratory predict CV reactivity in real life? (4) Are ambulatory cardiovascular measures predictive of cardiovascular disease?It is concluded that the hemodynamic processes that underlie the blood pressure response can reliably be measured in real life and the psychophysiological relationships seen in the laboratory have been obtained in real life as well. Studies examining the effects of specific real life stressors show that responses obtained in real life are often larger than those obtained in the laboratory. Subjective ratings of stress, emotion and cognitive determinants of real life stress (e.g. demand, reward and control) also relate to real life CV responses. Surprisingly, ambulatory studies on real life cardiovascular reactivity to stress as a predictor of cardiovascular disease are rare. Measuring the CV response to stress in real life may provide a better measure of the stress-related process that are hypothesized to cause disease than is possible in the laboratory. In addressing these questions, below we review the studies that we believe are representative of the field. Therefore, this review is not comprehensive.     

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.     

Type A Behavior and Psychophysiological Responses in Adult Women

The purpose of this study was to assess both coronary-prone behavior and physiological responses to stress in adult women. Forty-one women, aged 25–55, were tested; half were professional or executive-level employed women, the remainder were housewives. Based on the Jenkins Activity Survey, the working women scored as strong Type A's; the housewife group contained both A's and B's. The heart rate, blood pressure and skin conductance responses were compared for these groups while they rested, performed math problems, and attempted to solve visual puzzles. Type A women showed higher heart rates and larger increases in systolic and diastolic blood pressure; Type B women showed larger phasic heart rate decelerations. Employment was not a prerequisite for increased cardiovascular responsivity in Type A's; however, the unemployed Type A's indicated a desire to work. Given the similarities between employment status, Type A behavior and physiological responses in these working women as compared to men, their risk for coronary heart disease may also be similar.