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.     

Forced expiratory volume is associated with cardiovascular and cortisol reactions to acute psychological stress

It has been argued that blunted cardiovascular and cortisol reactions to acute psychological stress reflect a dysregulation of the neural system that supports motivation. We examined the association between forced expiratory volume in 1 s, an effort (hence motivation) dependent measure of lung function measured by spirometry, and cardiovascular and cortisol reactions to a battery of standard psychological stress tasks, assessed 7 years later. Irrespective of how it was expressed, low forced expiratory volume was associated with blunted heart rate and cortisol stress reactivity. The association survived adjustment for smoking, a range of anthropometric and sociodemographic covariates, and commitment to the stress tasks, as well as cognitive ability.     

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.     

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 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.     

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.     

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.     

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.     

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.     

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.     

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

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.     

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.     

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.     

Brief Reports: Further evidence for an association between self‐reported health and cardiovascular as well as cortisol reactions to acute psychological stress

In a recent study, the association between cardiovascular reactions to acute psychological stress and self‐reported health was examined. Participants with excellent or good self‐reported health exhibited higher cardiovascular reactivity than those who reported fair or poor health. We investigated this association in a population‐based cohort of whom 725 men and women, aged 55–60 years, participated in a standardized psychological stress test. We measured continuous blood pressure and heart rate as well as cortisol reactivity. Good subjective health was associated with higher cardiovascular and cortisol reactions to psychological stress. Results of the present study confirm those of the previously reported study showing that greater cardiovascular reactivity may not always be associated with negative health outcomes. In addition, the same holds for cortisol reactivity.     

Mechanisms underlying hemodynamic and neuroendocrine stress reactivity at different phases of the menstrual cycle

This study examined the association of menstrual cycle phase with stress reactivity as well as the hormonal and neuroendocrine mechanisms contributing to cycle effects. Fifty‐seven women underwent a modified Trier Social Stress Test during the early follicular, late follicular, and luteal phases of the menstrual cycle. Greater increases in cardiac index (CI) and greater decreases in vascular resistance index (VRI) during speech were observed in the luteal phase relative to other phases, while greater increases in epinephrine (EPI) was observed during the late follicular and luteal phases compared to the early follicular phase. Luteal phase estradiol predicted luteal EPI reactivity but not CI or VRI reactivity, while luteal phase EPI reactivity predicted luteal phase CI and VRI reactivity. Thus, cycle‐related changes in EPI reactivity may be a stronger determinant of cycle effects on hemodynamic reactivity than sex hormones per se.     

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.     

Blood pressure, heart rate, and behavioral responses to psychological "novelty" stress in freely moving rats

We developed a new model of psychological "open-field" stress in freely moving rats. Blood pressure and heart rate of the rats were measured by radiotelemetry and behavior analyzed by video tracking software. Open-field exposure induced marked increases in blood pressure and heart rate. Repeated daily exposure induced pressor responses that were slightly higher on Day 4 when compared to Day 1. Pretreatment with the beta1-adrenoceptor antagonist atenolol inhibited the tachycardia whereas the ganglion blocker pentolinium inhibited the pressor response, indicating involvement of the sympathetic nervous system. Pretreatment with diazepam prevented the novelty stress-induced pressor response and reduced the tachycardia. These results show that the psychological stress of exposing rats to an open field induces marked cardiovascular effects that are mediated by sympathetic hyperactivity. This model is unique in that it focuses on psychological stress and allows concomitant measurement of blood pressure, heart rate, and behavior in freely moving rats.     

Speaking under pressure: Low linguistic complexity is linked to high physiological and emotional stress reactivity

What can a speech reveal about someone's state? We tested the idea that greater stress reactivity would relate to lower linguistic cognitive complexity while speaking. In Study 1, we tested whether heart rate and emotional stress reactivity to a stressful discussion would relate to lower linguistic complexity. In Studies 2 and 3, we tested whether a greater cortisol response to a standardized stressful task including a speech (Trier Social Stress Test) would be linked to speaking with less linguistic complexity during the task. We found evidence that measures of stress responsivity (emotional and physiological) and chronic stress are tied to variability in the cognitive complexity of speech. Taken together, these results provide evidence that our individual experiences of stress or “stress signatures”—how our body and mind react to stress both in the moment and over the longer term—are linked to how complex our speech under stress.     

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.