Haemodynamic and electrodermal correlates of psychogenic stimuli in hypertensive and normotensive subjects

Physiological reactivity to acute mental stress in essential hypertension-a systematic review

Objective

Exaggerated physiological reactions to acute mental stress (AMS) are associated with hypertension (development) and have been proposed to play an important role in mediating the cardiovascular disease risk with hypertension. A variety of studies compared physiological reactivity to AMS between essential hypertensive (HT) and normotensive (NT) individuals. However, a systematic review of studies across stress-reactive physiological systems including intermediate biological risk factors for cardiovascular diseases is lacking.

Methods

We conducted a systematic literature search (PubMed) for original articles and short reports, published in English language in peer-reviewed journals in November and December 2022. We targeted studies comparing the reactivity between essential HT and NT to AMS in terms of cognitive tasks, public speaking tasks, or the combination of both, in at least one of the predefined stress-reactive physiological systems.

Results

We included a total of 58 publications. The majority of studies investigated physiological reactivity to mental stressors of mild or moderate intensity. Whereas HT seem to exhibit increased reactivity in response to mild or moderate AMS only under certain conditions (i.e., in response to mild mental stressors with specific characteristics, in an early hyperkinetic stage of HT, or with respect to certain stress systems), increased physiological reactivity in HT as compared to NT to AMS of strong intensity was observed across all investigated stress-reactive physiological systems.

Conclusion

Overall, this systematic review supports the proposed and expected generalized physiological hyperreactivity to AMS with essential hypertension, in particular to strong mental stress. Moreover, we discuss potential underlying mechanisms and highlight open questions for future research of importance for the comprehensive understanding of the observed hyperreactivity to AMS in essential hypertension.

Habituation of the electrodermal response - A biological correlate of resilience?

Current approaches to quantifying resilience make extensive use of self-reported data. Problematically, this type of scales is plagued by response distortions–both deliberate and unintentional, particularly in occupational populations. The aim of the current study was to develop an objective index of resilience. The study was conducted in 30 young healthy adults. Following completion of the Connor-Davidson Resilience Scale (CD-RISC) and Depression/Anxiety/Stress Scale (DASS), they were subjected to a series of 15 acoustic startle stimuli (95 dB, 50 ms) presented at random intervals, with respiration, skin conductance and ECG recorded. As expected, resilience (CD-RISC) significantly and negatively correlated with all three DASS subscales–Depression (r = -0.66, p<0.0001), Anxiety (r = -0.50, p<0.005) and Stress (r = -0.48, p<0.005). Acoustic stimuli consistently provoked transient skin conductance (SC) responses, with SC slopes indexing response habituation. This slope significantly and positively correlated with DASS-Depression (r = 0.59, p<0.005), DASS-Anxiety (r = 0.35, p<0.05) and DASS-Total (r = 0.50, p<0.005) scores, and negatively with resilience score (r = -0.47; p = 0.006), indicating that high-resilience individuals are characterized by steeper habituation slopes compared to low-resilience individuals. Our key finding of the connection between habituation of the skin conductance responses to repeated acoustic startle stimulus and resilience-related psychometric constructs suggests that response habituation paradigm has the potential to characterize important attributes of cognitive fitness and well-being–such as depression, anxiety and resilience. With steep negative slopes reflecting faster habituation, lower depression/anxiety and higher resilience, and slower or no habituation characterizing less resilient individuals, this protocol may offer a distortion-free method for objective assessment and monitoring of psychological resilience.

Arterial blood pressure and general sympathetic activation in essential hypertension during stimulation

We asked whether exaggerated blood pressure (BP) reactivity in patients with essential hypertension (HT) is a sign of specific activation of the cardiovascular system or of generalized sympathetic activation. Fourteen patients with essential hypertension and 14 matched normotensive (NT) controls were subjected to tasks involving attentional demands, mental arithmetic, a cold pressor test and isometric muscular contraction. Systolic and diastolic BPs, skin and muscle blood flows, heart rate, skin conductance level and fluctuations during each task were recorded. Urine samples for determination of epinephrine and norepinephrine excretion were collected after task completion. All tasks caused BP increases in both groups. HT showed greater absolute and percentage BP reactivity than NT during isometric muscle contraction. Variables for which reactivity differences were observed were poorly correlated across tasks both in HT and NT, whereas resting values prior to each task were highly correlated in both groups. Skin conductance activity, epinephrine and norepinephrine excretion rates being examples of non-cardiovascular sympathetic nervous system (SNS) indicators did not separate HT from NT. Thus, the exaggerated pressor response in HT is not accompanied by signs of generalized SNS activation.

Cardiovascular recovery from stress and hypertension risk factors: a meta-analytic review

Recent research has suggested that cardiovascular recovery from stress can play a potential role in hypertension pathogenesis. Sixty-nine studies were included in a meta-analytic review to evaluate the effect of various hypertension risk factors (e.g., race, lack of exercise) on cardiovascular recovery from stress. Small mean effect sizes were observed for studies examining hypertension status and race as risk factors associated with delayed diastolic blood pressure recovery. Lack of fitness was also associated with delayed heart rate recovery. These results revealed that, for the specified risk factors and cardiovascular variables, high-risk individuals exhibited delayed cardiovascular recovery as compared with low-risk individuals. Further, the relationships between hypertension status, race, and cardiovascular recovery were typically associated with the use of "active" laboratory stressors. The relationship between lack of fitness and cardiovascular recovery was also associated with the use of "active" and exercise laboratory stressors.

Pressor reactions to psychological stress and prediction of future blood pressure: data from the Whitehall II Study

OBJECTIVE

To examine whether reactions of blood pressure to psychological stress predict future blood pressure.

DESIGN

Blood pressure was recorded at a medical screening examination after which pressor reactions to a psychological stress task were determined. Follow up measurement of blood pressure was undertaken, on average, 4.9 years later.

SETTING

20 civil service departments in London.

SUBJECTS

1003 male civil servants aged between 35 and 55 years at entry to the study.

MAIN OUTCOME MEASURE

Blood pressure at follow up screening.

RESULTS

Reactions of systolic blood pressure to stress correlated positively with systolic blood pressure at follow up screening (r = 0.22, P < 0.01). The dominant correlate of follow up blood pressure was blood pressure at initial screening (r = 0.60; P < 0.01 between initial and follow up systolic blood pressure; r = 0.59, P < 0.01 between initial and follow up diastolic blood pressure). Stepwise multiple regression analysis indicated that reactions to the stressor provided minimal prediction of follow up blood pressure over and above that afforded by blood pressure at initial screening. In the case of follow up systolic blood pressure, systolic reactions to stress accounted for only 1% of follow up variance; systolic blood pressure at initial screening accounted for 34%. With regard to diastolic blood pressure at follow up, the independent contribution from diastolic reactions to stress was less than 1%.

CONCLUSION

Pressor reactions to psychological stress provide minimal independent prediction of blood pressure at follow up. Measurement of reactivity is not a useful clinical index of the course of future blood pressure.

Effect of positive family history of hypertension on the blood pressure and catecholamine responses to a 6 hour adrenaline infusion

1. The effects of 6 h infusion of adrenaline (INF-A) or dextrose (INF-D) and of post-infusion cold pressor test (CPT) were compared in normal subjects, with (FH+) and without (FH-) a family history of hypertension. 2. Increased urinary excretion rates suggested facilitated noradrenaline (NA) release during and after INF-A in both FH+ and FH-. 3. Urinary adrenaline (UADR) excretion increased during INF-A, as expected, and was also slightly higher after INF-A than INF-D. 4. The effect of INF-A on systolic blood pressure (SBP) was greater in FH- than in FH+ but diastolic blood pressure (DBP) did not fall as quickly with nocturnal recumbency after INF-A in FH+. 5. A significantly greater response in plasma NA to CPT was seen in FH+ than in FH- after INF-A. A similar trend was also seen after INF-D. 6. Increases in DBP due to CPT were higher in FH+ than in FH- after both infusions. 7. This study provides evidence of increased noradrenergic activity during and after INF-A, and also of a difference in response to sympathetic stimulation between FH+ and FH-.

Cardiac autonomic mechanisms associated with borderline hypertension under varying behavioral demands: evidence for attenuated parasympathetic tone but not for enhanced beta-adrenergic activity

Elevated blood pressure in psychophysiological studies of borderline hypertension is frequently attributed to the effects of increased sympathetic tone, and with few exceptions, the potential parasympathetic contributions have not been considered. Furthermore, of the investigations that have addressed vagal influences upon blood pressure, most have employed invasive pharmacological assessment of parasympathetic tone. In this study, cardiac parasympathetic and beta-adrenergic influences in borderline hypertension were evaluated noninvasively employing respiratory sinus arrhythmia as a vagal index and preejection period as a sympathetic index of cardiac functioning. Subjects were 30 borderline hypertensive and 23 normotensive males (age range, 24-45 years). The ECG, blood pressure, impedance cardiography, and respiration were measured during two baselines (initial and post-task), a memory-comparison reaction time task, the cold pressor, and CO2-rebreathing. Results indicated tonic differences between groups in all cardiovascular variables across tasks, with the exception of pre-ejection period, which showed no group effects at all. Hypertensives additionally manifested somewhat heightened systolic blood pressure reactivity and attenuated cardiac parasympathetic responsivity to specific tasks. Our findings provide no support for an exaggerated cardiac beta-adrenergic tonic level or reactivity in borderline hypertensives. On the other hand, the consistently lower magnitude of respiratory sinus arrhythmia in our hypertensives suggests that reduced parasympathetic control may be involved in the pathophysiology of hypertension.

Response patterns and cardiovascular effects during response sequence acquisition by humans

The effects of temporal delays imposed between successive responses and of vitamin C administration were examined on the acquisition of response sequences and on cardiovascular reactivity during sequence acquisition. Thirteen adult subjects (6 female, 7 male), in good health, gave written consent prior to participating in 12 weekly 45-min sessions. Points, exchanged for money after each session, were presented when subjects completed 15-response sequences on a touch-sensitive three-response keypad. A position counter increased from 0 to 14 as subjects emitted correct responses in the sequence. Four novel 15-response sequences were presented each session. No delays were imposed between successive responses during the acquisition of one sequence; delays were imposed immediately following each response during the acquisition of a second sequence, thereby delaying response feedback; delays were imposed following feedback during acquisition of a third sequence, resulting in the removal of the stimulus correlated with sequence position; and, as a control condition, delays were imposed following feedback, but stimuli correlated with sequence position were reinstated prior to the next response during acquisition of a fourth sequence. Subjects were exposed to one of two delay durations (0.2 and 0.5 or 0.5 and 1.0 s) each session, and delay durations alternated every session. During Weeks 5 to 8, subjects received 3 grams of vitamin C per day, whereas during Weeks 1 to 4 and 9 to 12, subjects received placebo under single-blind conditions. All subjects acquired the sequences, as evidenced by decreasing percentages of incorrect responses across trials. When temporal delays were imposed between successive responses during sequence acquisition, acquisition efficiency was enhanced. Examination of response latencies suggested that the status of preceding responses (i.e., correct or incorrect) rather than the status of the position counter influenced subsequent responding. Cardiovascular effects were inversely related to the length of the temporal delay. Neither cardiovascular reactivity or sequence acquisition were related to vitamin C administration.

Racial differences in cardiovascular reactivity to mental arithmetic

One hypothesized mechanism for the higher rates and greater severity of essential hypertension among blacks is that this group is particularly susceptible to stress-induced beta-adrenergically mediated cardiovascular hyperreactivity. In this study, we compared the cardiovascular responses to mental arithmetic in 20 white and 17 black, young, normotensive males. Contrary to expectations, the black subjects exhibited significantly smaller changes in heart rate, and systolic and diastolic blood pressure. These findings suggest that cardiovascular reactivity to a mental stressor known to produce beta-adrenergically mediated responses may be lower in some normotensive blacks compared to their white counterparts.

Learned control of heart rate during exercise in patients with borderline hypertension

Twelve patients with borderline hypertension [less than or equal to 21 X 33/12.6, greater than or equal to 18 X 6/12.0 kPa (less than or equal to 160/95; greater than or equal to 140/90 mm Hg)] participated in an experiment aimed at testing whether they could learn to attenuate heart rate while exercising on a cycle ergometer. Six experimental (E) subjects received beat-to-beat heart-rate feedback and were asked to slow heart rate while exercising; six control (C) subjects received no feedback. Averaged over 5 days (25 training trials) the exercise heart-rate of the E group was 97.8 bt min-1, whereas the C group averaged 107 bt min-1 (P = 0.03). Systolic blood pressure was unaffected by feedback training. Generally, changes in rate-pressure product reflected changes in heart-rate. Oxygen consumption was lower in the E than in the C group late in training. We conclude that neurally mediated changes associated with exercise in patients with borderline hypertension can be brought under behavioral control through feedback training.

Cardiovascular and electrodermal adjustments during a vigilance task in patients with borderline and established hypertension

We studied cardiovascular and noncardiovascular sympathetic nervous system (SNS) responses to a vigilance task in patients with borderline (BT) or established hypertension (HT). Twelve patients in each group and twelve normotensive controls (NT) were subjected to a signalled reaction-time (RT) task which included the presentation of a noxious 110 dB white noise contingent upon RT-performance at the end of a 30 sec foreperiod. During this foreperiod recordings were made of: systolic and diastolic blood pressures, heart rate, skin- and muscle-blood flows. Skin and muscle vascular resistances were calculated from mean blood pressure and regional blood flows. Skin conductance level, fluctuations and responses were recorded as noncardiovascular SNS-responses. Compared to NT both HT and BT had higher resting blood pressures, heart rate, skin- and muscle-vascular resistances. BT showed higher resting skin conductance levels than HT and NT who were not different from one another. During stimulation HT and BT evidenced pressor hyperreactivity compared to NT. The electrodermal effects did not parallel the cardiovascular ones. Skin conductance and cardiovascular variables were more closely related in NT than HT or BT. The presence of cardiovascular hyperreactivity together with the absence of noncardiovascular hyperreactivity in HT indicates heightened SNS-activity specific to the cardiovascular system and not part of generalized SNS-arousal. The similarity between HT and BT is consistent with the notion that the differences between BT and HT are quantitative rather than qualitative.