Cardiovascular reactivity: status quo and a research agenda for the new millennium

Acute Stress-Induced Blood Lipid Reactivity in Hypertensive and Normotensive Men and Prospective Associations with Future Cardiovascular Risk

Hyperreactivity to stress may be one explanation for the increased risk of cardiovascular disease (CVD) in individuals with essential hypertension. We investigated blood lipid reactivity to the Montreal Imaging Stress Task (MIST), a psychosocial stressor, in hypertensive and normotensive men and tested for prospective associations with biological risk factors. Fifty-six otherwise healthy and medication-free hypertensive and normotensive men underwent the MIST. We repeatedly measured cortisol and blood lipid profiles (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)) immediately before and up to 1 h after stress. Lipid levels were corrected for stress hemoconcentration. Thirty-five participants completed follow-up assessment 2.9 ± 0.12 (SEM) years later. CVD risk was assessed by prospective changes in TC/HDL-C ratio, IL-6, D-dimer, and HbA1c from baseline to follow-up. The MIST induced significant changes in all parameters except TC (p-values ≤ 0.043). Compared with normotensives, hypertensives had higher TC/HDL-C-ratio and TG (p-values ≤ 0.049) stress responses. Blood lipid stress reactivity predicted future cardiovascular risk (p = 0.036) with increases in HbA1c (ß = 0.34, p = 0.046), IL-6 (ß = 0.31, p = 0.075), and D-dimer (ß = 0.33, p = 0.050). Our results suggest that the greater blood lipid reactivity to psychosocial stress in hypertensives, the greater their future biological CVD risk. This points to lipid stress reactivity as a potential mechanism through which stress might increase CVD risk in essential hypertension.

Sex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans

PURPOSE OF REVIEW

Greater racial discrimination is associated with poorer mental health among Black Americans; yet, there remains an incomplete understanding of sex differences in exposure to racial discrimination, and further, of how sex differences in coping with racial discrimination may heighten or diminish risk for poorer mental health.

RECENT FINDINGS

Black men may experience greater exposure to both structural and communal forms of racial discrimination, whereas Black women may face both a wider range of potential sources, as well as encounter greater variability in the subjective experience of racial discrimination. For both Black women and men, racial discrimination may be similarly associated with maladaptive coping strategies (i.e., emotional eating, rumination) that also are linked to poorer mental health; however, emerging findings suggest that mindfulness may partially buffer these deleterious effects. Overall, the recent literature reveals mixed findings with respect to sex differences in the experience and negative mental health impact of racial discrimination. Despite this heterogeneity, evidence documents sex differences in the settings, type, and qualitative experience of racial discrimination among Black Americans. Additionally, growing evidence indicating that racial discrimination is associated with physiological markers of stress reactivity and psychopathology risk further bolsters its characterization as a unique form of chronic stress among Black Americans and other minority groups in the USA.

The Adaptive Value and Clinical Significance of Allostatic Blood Pressure Variation

In recent years, there has been interest in evaluating the morbidity and mortality risk of circadian, diurnal, or nocturnal blood pressure variation. Variation is a normative property of blood pressure, necessary for survival. Like many physiological functions, blood pressure undergoes allostasis, meaning that the body does not defend a particular blood pressure value, but rather blood pressure maintains bodily stability through continual change that is initiated by constantly fluctuating internal and external environmental stimuli. Because of its allostatic and adaptive properties, the blood pressure response to unusual situations like a visit to the clinic can lead to misdiagnosis of hypertension. However, blood pressure variation is mostly ignored when evaluating hypertension, which is an arbitrary dichotomy. Whether variation is indicative of pathology should be determined by assessing its appropriateness for the circumstance, which requires quantification of the sources and extent of normative blood pressure responses to everyday living. These responses will vary among populations due to evolutionary genetic differences. The inconsistency of reports regarding aspects of ambulatory blood pressure variation as cardiovascular risk factors likely results from the fact that the measures used do not reflect the actual nature of blood pressure allostasis.

Neuroimmune Mechanisms of Depression in Adults with Heart Failure

Heart failure (HF) is a major and costly public health concern, and its prognosis is grim-with high hospitalization and mortality rates. HF affects millions of individuals across the world, and this condition is expected to become "the epidemic" of the twenty-first century (Jessup et al., 2016). It is well documented that individuals with HF experience disproportionately high rates of depression and that those who are depressed have worse clinical outcomes than their nondepressed counterparts. The purpose of this chapter is to introduce the reader to the study of depression in HF, and how psychoneuroimmunologic principles have been applied to further elucidate mechanisms (i.e., neurohormonal and cytokine activation) linking these comorbid disorders.

Effects of Religious Orientation and Gender on Cardiovascular Reactivity Among Older Adults

Recent attention has focused on the relationship between religiosity and health. Although many pathways have been proposed to account for this relationship, little empirical research has investigated specific pathways in relation to specific physiological functions. This study assessed the roles that religious orientation and gender play in moderating psychophysiological reactivity to laboratory stressors among older adults. Those participants characterized by an intrinsic religious orientation (IO) demonstrated less reactivity than did those characterized by an extrinsic religious orientation. Gender did not influence reactivity. There was some evidence that the effect of religious orientation is more pronounced for interpersonal than cognitive-type stressors, although the strongest findings were evident when stressors were aggregated. The magnitude of these effects suggests that they are of practical significance. Given these results and the known relationship between reactivity and hypertension, it is proposed that IO may result in decreased risk of developing hypertension in older adults.

Pilot Randomized Study of a Gratitude Journaling Intervention on Heart Rate Variability and Inflammatory Biomarkers in Patients With Stage B Heart Failure

OBJECTIVE

Stage B, asymptomatic heart failure (HF) presents a therapeutic window for attenuating disease progression and development of HF symptoms, and improving quality of life. Gratitude, the practice of appreciating positive life features, is highly related to quality of life, leading to development of promising clinical interventions. However, few gratitude studies have investigated objective measures of physical health; most relied on self-report measures. We conducted a pilot study in Stage B HF patients to examine whether gratitude journaling improved biomarkers related to HF prognosis.

METHODS

Patients (n = 70; mean [standard deviation] age = 66.2 [7.6] years) were randomized to an 8-week gratitude journaling intervention or treatment as usual. Baseline (T1) assessments included the six-item Gratitude Questionnaire, resting heart rate variability (HRV), and an inflammatory biomarker index. At T2 (midintervention), the six-item Gratitude Questionnaire was measured. At T3 (postintervention), T1 measures were repeated but also included a gratitude journaling task.

RESULTS

The gratitude intervention was associated with improved trait gratitude scores (F = 6.0, p = .017, η = 0.10), reduced inflammatory biomarker index score over time (F = 9.7, p = .004, η = 0.21), and increased parasympathetic HRV responses during the gratitude journaling task (F = 4.2, p = .036, η = 0.15), compared with treatment as usual. However, there were no resting preintervention to postintervention group differences in HRV (p values > .10).

CONCLUSIONS

Gratitude journaling may improve biomarkers related to HF morbidity, such as reduced inflammation; large-scale studies with active control conditions are needed to confirm these findings.

TRIAL REGISTRATION

Clinicaltrials.govidentifier:NCT01615094.

Attributional styles and stress-related atherogenic plasma lipid reactivity in essential hypertension

OBJECTIVE

Hypertension and an atherogenic lipid profile are known risk factors for coronary heart disease (CHD). Hypertensives show greater changes in atherogenic plasma lipids to acute stress than normotensives. In this study, we investigated whether attribution of failure is associated with lipid stress reactivity in hypertensive compared with normotensive men.

METHODS

18 normotensive and 17 hypertensive men (mean±SEM; 45±2.2 years) underwent an acute standardized psychosocial stress task that can be viewed as a situation of experimentally induced failure. We assessed external-stable (ES), external-variable (EV), internal-stable (IS), and internal-variable (IV) attribution of failure and psychological control variables (i.e. extent of depression and neuroticism). Moreover, total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and norepinephrine were measured immediately before and several times after stress.

RESULTS

ES moderated TC- and LDL-C-stress reactivity in hypertensives as compared to normotensives (interaction mean arterial pressure [MAP]-by-ES for TC: F=3.71, p=.015; for LDL-C: F=3.61, p=.016). TC and LDL-C levels were highest in hypertensives with low ES immediately after stress (p≤.039). In contrast, hypertensives with high ES did not differ from normotensives in TC and LDL-C immediately after stress (p's>.28). Controlling for norepinephrine, depression, and neuroticism in addition to age and BMI did not significantly change results. There were no significant associations between lipid baseline levels or aggregated lipid secretion and IS, IV, or EV (p's>.23).

CONCLUSION

Our data suggest that ES may independently protect from elevated lipid stress reactivity in hypertensive individuals. ES thus might be a protective factor against CHD in hypertension.

Marital quality and health: a meta-analytic review

This meta-analysis reviewed 126 published empirical articles over the past 50 years describing associations between marital relationship quality and physical health in more than 72,000 individuals. Health outcomes included clinical endpoints (objective assessments of function, disease severity, and mortality; subjective health assessments) and surrogate endpoints (biological markers that substitute for clinical endpoints, such as blood pressure). Biological mediators included cardiovascular reactivity and hypothalamic-pituitary-adrenal axis activity. Greater marital quality was related to better health, with mean effect sizes from r = .07 to .21, including lower risk of mortality (r = .11) and lower cardiovascular reactivity during marital conflict (r = -.13), but not daily cortisol slopes or cortisol reactivity during conflict. The small effect sizes were similar in magnitude to previously found associations between health behaviors (e.g., diet) and health outcomes. Effect sizes for a small subset of clinical outcomes were susceptible to publication bias. In some studies, effect sizes remained significant after accounting for confounds such as age and socioeconomic status. Studies with a higher proportion of women in the sample demonstrated larger effect sizes, but we found little evidence for gender differences in studies that explicitly tested gender moderation, with the exception of surrogate endpoint studies. Our conclusions are limited by small numbers of studies for specific health outcomes, unexplained heterogeneity, and designs that limit causal inferences. These findings highlight the need to explicitly test affective, health behavior, and biological mechanisms in future research, and focus on moderating factors that may alter the relationship between marital quality and health.

Neuroimmune mechanisms of depression in heart failure

Heart failure (HF) is a major and costly public health concern, and its prognosis is grim-with high hospitalization and mortality rates. It is well documented that HF patients experience disproportionately high rates of depression and that depressed HF patients have worse clinical outcomes than their non-depressed counterparts. The purpose of this chapter is to introduce the reader to the study of depression in HF, and how psychoneuroimmunologic principals have been applied to further elucidate the mechanisms (i.e., neurohormonal and cytokine activation) linking these co-morbid disorders.

"Shift-and-Persist" Strategies: Why Low Socioeconomic Status Isn't Always Bad for Health

Some individuals, despite facing recurrent, severe adversities in life such as low socioeconomic status (SES), are nonetheless able to maintain good physical health. This article explores why these individuals deviate from the expected association of low SES and poor health and outlines a "shift-and-persist" model to explain the psychobiological mechanisms involved. This model proposes that, in the midst of adversity, some children find role models who teach them to trust others, better regulate their emotions, and focus on their futures. Over a lifetime, these low-SES children develop an approach to life that prioritizes shifting oneself (accepting stress for what it is and adapting the self through reappraisals) in combination with persisting (enduring life with strength by holding on to meaning and optimism). This combination of shift-and-persist strategies mitigates sympathetic-nervous-system and hypothalamic-pituitary-adrenocortical responses to the barrage of stressors that low-SES individuals confront. This tendency vectors individuals off the trajectory to chronic disease by forestalling pathogenic sequelae of stress reactivity, like insulin resistance, high blood pressure, and systemic inflammation. We outline evidence for the model and argue that efforts to identify resilience-promoting processes are important in this economic climate, given limited resources for improving the financial circumstances of disadvantaged individuals.

Coconut fragrance and cardiovascular response to laboratory stress: results of pilot testing

There is preliminary evidence that pleasant fragrances may alter response to stressors in different settings. This pilot study examined the effect of coconut fragrance on cardiovascular response to standard laboratory stressors. While inhaling coconut fragrance (n = 17) or air (n = 15), subjects performed a Stroop color-word task and a mental arithmetic task. Heart rate (HR), heart period variability (HPV) and blood pressure were measured during the 5-minute baseline, the task, and the recovery periods. The results indicated that subjects breathing coconut fragrance had higher HR and lower HPV than those who performed tasks while breathing air. HR response to mental arithmetic seemed to be blunted in the subjects breathing coconut; however, the lack of a difference in HPV seems to indicate that the blunting may be due to decreased sympathetic response, not decreased parasympathetic withdrawal under stress. Blood pressure recovery was slightly enhanced in subjects under coconut fragrance. Thus, the results of this pilot test suggest that coconut fragrance may alter cardiovascular activity both at rest and in response to stressors. Future experimentation should attempt to replicate and extend these findings in larger samples in clinical settings.

Depression as a potential modulator of Beta-adrenergic-associated leukocyte mobilization in heart failure patients

OBJECTIVES

the aim of this study was to determine whether depressive symptoms are related to alterations in the sensitivity of peripheral blood mononuclear cells to β-adrenergic agonists in patients with heart failure (HF) by measuring in vitro chemotaxis (CTX) to isoproterenol at rest and after acute exercise in patients with HF and controls.

BACKGROUND

clinical outcomes are worse for patients with HF presenting with symptoms of depression. Sympathetically modulated immune dysregulation associated with depression may be one mechanism leading to worse prognosis.

METHODS

seventy-seven patients with HF and 44 controls (mean age 56.4 ± 1.3 years) completed the Beck Depression Inventory and a 15-min mild-graded exercise task on a stationary bicycle. Exercise intensity was kept relative to fitness levels for all participants by gradually increasing resistance to reach a Borg scale subjective rating of 12 to 13, "somewhat hard." Plasma norepinephrine and epinephrine levels were measured before and after exercise. Chemotaxis to isoproterenol was determined by measuring in vitro peripheral blood mononuclear cell migration through a modified Boyden chamber.

RESULTS

In patients with HF, depressive symptom severity was associated with greater CTX after exercise (p = 0.001). Higher resting norepinephrine in patients with HF was also associated with increased CTX to exercise (p = 0.03).

CONCLUSIONS

patients with HF with higher depressive symptoms and norepinephrine exhibited increased peripheral blood mononuclear cell CTX to isoproterenol to mild exercise, suggesting greater β-adrenergic sensitivity. Increased immune migration in patients with HF who have elevated depressive symptoms could be associated with cardiac remodeling and HF disease progression.

Appraisal predicts hemodynamic reactivity in a naturalistic stressor

Prior research has shown that appraisals are predictive of hemodynamic reaction patterns. The current study examined the relationship between appraisal and hemodynamic responding in a real-life stressful situation. Twenty-four men aged 19-28 wore a blood pressure monitor while presenting a paper in a class. Participant's appraisal self-reports were obtained prior to the stressor. Multilevel regression models were used to analyze the relationships between appraisal and myocardial responding (as measured by cardiac output) and vascular resistance (as measured by TPR). Pre-stressor appraisals were significantly associated with CO, both during the stressor (Z=2.03 p<.05) as well as during the 30-minute anticipation period preceding the stressor (Z=2.43 p<.01). In line with the predictions, relatively challenged participants showed higher CO. Pre-stressor appraisals significantly predicted TPR during anticipation (Z=2.70 p<.01) but these associations failed to reach significance during the stressor (Z=1.82, n.s.). As was predicted, during anticipation, increased threat was associated with increased TPR. Thus, during the anticipation period prior to the stressor, increased challenge was associated with decreased vascular resistance and increased myocardial reactivity. Further, increased threat was associated with increased vascular resistance and decreased myocardial reactivity. During the stressor increases in challenge were associated with further increases in myocardial responding but relationships between appraisal and vascular resistance were not significant. The current study shows that the relationship between appraisal and hemodynamic reactivity seen in laboratory studies are also present during naturally occurring stress. Our findings suggest that threat appraisals to naturalistic stressors contribute to an, arguably unhealthy, vascular reaction pattern.

A potential shift from adaptive immune activity to nonspecific inflammatory activation associated with higher depression symptoms in chronic heart failure patients

BACKGROUND

Chronic heart failure (CHF) patients with elevated depression symptoms are at greater risk of morbidity and mortality. The mechanisms linking symptoms of depression with disease progression in CHF are unclear. However, research studies have found evidence of alterations in immune activity associated with depression symptoms that may influence heart function. The present study sought to determine the relationship between depression symptoms and chemotaxis of peripheral blood mononuclear cells (PBMCs) in CHF patients, both at rest and in response to moderate exercise.

METHODS AND RESULTS

Sixty-five patients diagnosed with CHF (mean age, 59.8 +/- 14.5 years) and 45 non-CHF control subjects (mean age, 52.1 +/- 11.6) completed the Beck Depression Inventory (BDI) before undergoing a moderate 20-minute bicycle exercise task. Chemotaxis of PBMCs was examined in vitro to a bacterial peptide f-met leu phe (fMLP) and a physiologic chemokine, stromal cell derived factor-1 (SDF-1) immediately before and after exercise. CHF patients had reduced chemotaxis to SDF-1 (P = .025) compared with non-CHF subjects. Higher BDI scores were associated with reduced baseline chemotaxis to SDF-1 in both CHF and non-CHF subjects (P = .027). In contrast, higher BDI scores were associated with increased chemotaxis to fMLP (P = .049) and SDF-1 (P = .018) in response to exercise in the CHF patients.

CONCLUSION

The present study suggests a shift in immune cell mobility in CHF patients with greater depression symptom severity, with reduced chemotaxis to a physiologically specific chemokine at rest but increased chemotaxis to both nonspecific and specific chemical attractants in response to physical activity. This could have implications for cardiac repair and remodeling in CHF patients and therefore may affect disease progression.

The level of physical activity affects adrenal and cardiovascular reactivity to psychosocial stress

Physical activity plays a key role in the control of neuroendocrine, autonomic, and behavioral responses to physical and psychosocial stress. However, little is known about how the level of physical activity modulates stress responsiveness. Here, we test whether different levels of physical activity are associated with different adrenal, cardiovascular, and psychological responses to psychosocial stress. In addition, competitiveness is assessed as a personality trait that possibly modulates the relationship between physical activity and stress reactivity. Eighteen elite sportsmen, 50 amateur sportsmen, and 24 untrained men were exposed to a standardized psychosocial laboratory stressor (Trier Social Stress Test). Repeated measures of salivary free cortisol, heart rate, and psychological responses to psychosocial stress were compared among the 3 study groups. Elite sportsmen exhibited significantly lower cortisol, heart rate, and state anxiety responses compared with untrained subjects. Amateur sportsmen showed a dissociation between sympathetic and hypothalamic-pituitary-adrenal responsiveness to stress, with significantly reduced heart rate responses but no difference in cortisol responses compared with untrained men. Different levels of competitiveness among groups did not mediate stress reactivity. Our results are in line with previous studies indicating reduced reactivity of the autonomic nervous system to psychosocial stress in trained individuals. More importantly, these findings imply a differential effect of the level of physical activity on different stress-related neurophysiological systems in response to psychosocial stress.

Independent association between lower level of social support and higher coagulation activity before and after acute psychosocial stress

OBJECTIVE

To investigate the relationship between social support and coagulation parameter reactivity to mental stress in men and to determine if norepinephrine is involved. Lower social support is associated with higher basal coagulation activity and greater norepinephrine stress reactivity, which in turn, is linked with hypercoagulability. However, it is not known if low social support interacts with stress to further increase coagulation reactivity or if norepinephrine affects this association. These findings may be important for determining if low social support influences thrombosis and possible acute coronary events in response to acute stress. We investigated the relationship between social support and coagulation parameter reactivity to mental stress in men and determined if norepinephrine is involved.

METHODS

We measured perceived social support in 63 medication-free nonsmoking men (age (mean +/- standard error of the mean) = 36.7 +/- 1.7 years) who underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience. We measured plasma D-dimer, fibrinogen, clotting Factor VII activity (FVII:C), and plasma norepinephrine at rest as well as immediately after stress and 20 minutes after stress.

RESULTS

Independent of body mass index, mean arterial pressure, and age, lower social support was associated with higher D-dimer and fibrinogen levels at baseline (p < .012) and with greater increases in fibrinogen (beta = -0.36, p = .001; DeltaR(2) = .12), and D-dimer (beta = -0.21, p = .017; DeltaR(2) = .04), but not in FVII:C (p = .83) from baseline to 20 minutes after stress. General linear models revealed significant main effects of social support and stress on fibrinogen, D-dimer, and norepinephrine (p < .035). Controlling for norepinephrine did not change the significance of the reported associations between social support and the coagulation measures D-dimer and fibrinogen.

CONCLUSIONS

Our results suggest that lower social support is associated with greater coagulation activity before and after acute stress, which was unrelated to norepinephrine reactivity.

Higher overcommitment to work is associated with lower norepinephrine secretion before and after acute psychosocial stress in men

BACKGROUND

Overcommitment (OC) is a pattern of excessive striving. In reaction to work stress, OC has been associated with higher sympathetic nervous system activation and cortisol release, but data on neuroendocrine reactivity to standardized stressors are scarce. We investigated whether OC is associated with differential levels of the stress hormones norepinephrine and cortisol in response to acute psychosocial stress.

METHODS

Fifty-eight medication-free non-smoking men aged between 20 and 65 years (mean+/-S.E.M.: 36.3+/-1.8) underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience. We assessed OC as well as a variety of psychological control variables including vital exhaustion, perfectionism, chronic stress, and cognitive stress appraisal. Moreover, we measured plasma norepinephrine as well as salivary cortisol before and after stress and several times up to 60 min thereafter.

RESULTS

Higher OC was associated with lower baseline norepinephrine levels (r = -0.37, p < 0.01). General linear models controlling for age, BMI, and mean arterial blood pressure revealed that higher overcommitment was associated with lower norepinephrine and cortisol levels before and after stress (p's < 0.02) as well as with lower norepinephrine stress reactivity (p = 0.02). Additional controlling for the potential psychological confounders vital exhaustion, perfectionism, chronic stress, and depression confirmed lower norepinephrine levels before and after stress (p < 0.01) as well lower norepinephrine stress reactivity (p = 0.02) with increasing OC. Higher OC independently explained 13% of the total norepinephrine stress response (beta = -0.46, p < 0.01, R(2) change = 0.13).

CONCLUSIONS

Our findings suggest blunted increases in norepinephrine following stress with increasing OC potentially mirroring blunted stress reactivity of the sympathetic nervous system.

Laboratory-based blood pressure recovery is a predictor of ambulatory blood pressure

The recovery phase of the stress response is an individual difference characteristic that may predict cardiovascular risk. The purpose of this study was to examine whether laboratory-based blood pressure (BP) recovery predicts ambulatory BP (ABP). One hundred and eighty-two participants underwent a standard laboratory stress protocol, involving a 20-min baseline rest period, and four stressors presented in a counterbalanced order, each followed by a 10-min recovery period. Participants also wore an ABP monitor for 24h during a typical workday. Hierarchical regression analyses showed that BP recovery accounted for significant additional variance for daytime SBP (p<0.001), nighttime SBP (p<0.001), daytime DBP (p<0.001), and nighttime DBP (p<0.001), after controlling for baseline and reactivity BP. Results suggest that persistence of the BP response following stress may be a more salient characteristic of the stress response in understanding its potential impact on longer term cardiovascular regulation.

Microanalysis of the relationship between goal self-efficacy and cardiovascular reactivity. A test for the moderating role of incentive value and the mediating role of anxiety

Eighty-three subjects were asked to solve a series of 15 mathematical problems after having been randomly assigned to an easy (5 problems) or to a difficult (9 problems) performance challenge. In addition to this, in order to create a sense of threat, subjects were told that a loud noise would be contingent upon failing to attain the performance challenge. Goal self-efficacy was computed from calculating the difference between self-efficacy level and the performance challenge. Intrinsic incentive value was derived from a six-item scale measuring the intensity of negative affects expected by the subject to be contingent upon a hypothetical failure to attain the goal. Systolic and diastolic blood pressure, and heart rate were collected during both the task performance and a prior rest phase. Anxiety-state was measured during the task performance as well. Statistical analyses revealed that interaction of goal self-efficacy and intrinsic incentive value partially predicted systolic blood pressure and heart rate reactivity. A main effect of self-efficacy was found on diastolic blood pressure. Overall, data best fitted to non-linear, quadratic functions in which either very low or very high self-efficacy, jointly with high incentive value, led to an enhanced cardiovascular reactivity. These findings are partially consistent with those previously obtained, and point to a complex model in which self-efficacy exerts specific effects on each cardiovascular parameter, usually in a non-monotonical way. Again, incentive value appeared as a moderator, but anxiety-state did not appear as a mediator of the relationship between goal self-efficacy and cardiovascular reactivity.

Low social support and poor emotional regulation are associated with increased stress hormone reactivity to mental stress in systemic hypertension

CONTEXT

There is strong evidence for a physiological hyperreactivity to stress in systemic hypertension, but data on associated or potentially moderating psychological factors are scarce.

OBJECTIVE

The objective of the study was to identify psychological correlates of physiological stress reactivity in systemic hypertension.

DESIGN

This was a cross-sectional, quasi-experimentally controlled study. Study participants underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience.

SETTING

The study was conducted in the population in the state of Zurich, Switzerland.

SUBJECTS

Subjects included 22 hypertensive and 26 normotensive men (mean +/- sem 44 +/- 2 yr).

MAIN OUTCOME MEASURES

We assessed the psychological measures social support, emotional regulation, and cognitive appraisal of the stressful situation. Moreover, we measured salivary cortisol and plasma epinephrine and norepinephrine before and after stress and several times up to 60 min thereafter as well as blood pressure and heart rate.

RESULTS

We found poorer hedonistic emotional regulation (HER) and lower perceived social support in hypertensives, compared with normotensives (P < 0.01). Compared with normotensives, hypertensives showed higher cortisol, epinephrine, and norepinephrine secretions after stress (P < 0.038) as well as higher systolic and diastolic blood pressure (P < 0.001). Cortisol reactivity and norepinephrine secretion were highest in hypertensive men with low HER (P < 0.05). In contrast, hypertensives with high HER did not significantly differ from normotensives in both cortisol and norepinephrine secretion after stress. Epinephrine secretion was highest in hypertensives with low social support but was not different between hypertensives with high social support and normotensives.

CONCLUSIONS

The findings suggest that both low social support and low HER are associated with elevated stress hormone reactivity in systemic hypertension.

Assessing cardiovascular reactivity in working women with the social competence interview

The Social Competence Interview (SCI), an interview to induce cardiovascular reactivity through recounting a stressful life experience, was used with a sample of 120 working women employed as childcare providers. Women recounted their most stressful work factor while cardiovascular reactions were monitored at 2-minute intervals (data points included 4 baseline, 6 SCI, and 3 recovery). Increases were found when comparing mean baseline and SCI measures: systolic blood pressure (SBP) increased 10.00 mmHg; diastolic blood pressure (DBP)increased 10.63 mmHg; and heart rate increased 4.57 beats per minute. Consistent with the literature SBP and DBP were higher for some subgroups of women (those who were 50 years or older, were obese, or had 4 or more risk factors) across all data points. There were no time by individual difference interactions, indicating that the patterns of change over time were the same across groups. In a logistic regression, comparing women who reached SBP > or = 140 mmHg and/or DBP > or = 90 mmHg during the SCI versus those who did not, higher BP was associated with being older and obese, having a higher level of acceptance coping, and a lower level of suppression of competing activities coping.

Aging and cardiovascular reactivity to stress: longitudinal evidence for changes in stress reactivity

Although age differences in cardiovascular function are well documented, little research has provided longitudinal evidence for age-related changes in cardiovascular reactivity to stress. In this study, the authors report such data from a follow-up of their prior work (B. N. Uchino, D. Uno, J. Holt-Lunstad, & J. B. Flinders, 1999) with participants between the ages of 30 to 70 (n=108, mean follow-up=10 months, range=7 to 16 months). Results revealed longitudinal evidence for an age-related increase in systolic blood-pressure reactivity and parasympathetic withdrawal to acute stress. The implications of these findings are discussed in light of the increased cardiovascular disease risk with age, as well as the links between aging, emotions, and physiology.

Interactive effects of avoidant coping and parental hypertension on Rate Pressure Product reactivity in women

BACKGROUND

Previous research suggests that personality, situational context variables, and genes might interact to potentiate cardiovascular stress responses.

PURPOSE

Our purpose is to examine interactive effects of dispositional avoidant coping and parental hypertension on cardiovascular reactivity to three different laboratory stressors.

METHOD

Participants were 63 healthy female students. Stressors were an evaluated videotaped speech, the cold pressor, and viewing of the speech video. Heart rate and blood pressure were continuously recorded during baselines and tasks.

RESULTS

After controlling for age, body mass index, smoking status, reported exercise, alcohol consumption, oral contraceptive use, parental hypertension, and avoidant coping, the interaction term of parental hypertension and avoidant coping was the best predictor of rate pressure product (RPP) reactivity to the speech task and to the video-viewing task. In contrast, reactivity to the cold pressor was not significantly predicted by this interaction term. Furthermore, there were no significant main effects of parental hypertension and avoidant coping on RPP reactivity in any of the tasks. There were no significant interactive effects for diastolic blood pressure.

CONCLUSIONS

Consistent with an interactive model of cardiovascular reactivity, parental hypertension plus avoidant coping led to enhanced RPP reactivity. This effect, however, was only evident during self-threatening stressors. The results suggest that the coincidence of genetic and personality factors might enhance risk for cardiovascular diseases.

Cardiovascular reactivity in a simulated job interview: The role of gender role self-concept

This study investigated the relation of gender role self-concept (G-SC) to cardiovascular and emotional reactions to an ecologically relevant stressor in a sample of graduating male and female university students. Thirty-seven men and 37 women completed the Personal Attribute Questionnaire and worked on four tasks designed to reflect common features of a job interview. Blood pressure and heart rate were measured at baseline, during, and after each task; subjective stress was measured at baseline and after each task. Subjective and objective stress scores were averaged across tasks and analyzed by sex and G-SC (i.e., instrumentality, expressiveness). Results indicated that women as a group demonstrated greater emotional reactivity, but did not differ in their physiological reactions when compared to men. Regardless of sex, participants' instrumentality scores contributed significantly to the variation in subjective stress response: those scoring high on instrumentality reported less stress, but evidenced greater blood pressure reactivity than those scoring low on instrumentality. These results suggest that gender roles, particularly an instrumental self-concept, may play an important role in both subjective and objective reactions to an ecologically relevant stressor.

Urinary catecholamine levels in daily life are elevated in women at familial risk of breast cancer

Recent experimental research has shown that women facing the chronic stress of being at familial risk of breast cancer have greater neuroendocrine reactivity responses to stressful laboratory tasks. Whether this enhanced stress response also occurs outside the laboratory under daily life conditions is unknown. In the present study, urinary epinephrine and norepinephrine excretion rates at work (e.g. 11:00 AM-3:00 PM), home (e.g. 6:00 PM-10:00 PM) and during sleep (e.g. 10:00 PM-6:00 AM) were compared between 73 employed women with family histories of breast cancer in first degree relatives (FH+; age=36.8+/-8.7) and 81 without such family histories (FH-; age=38.1+/-9.4). Differences in sympathetic adrenal medullary responses to an ordinary life stressor (work) were assessed in naturalistic settings. Repeated measures MANCOVA with family history group as a fixed factor, body mass index as a covariate and daily microenvironment (work, home and sleep) as a repeating factor were conducted to evaluate whether catecholamine excretion rates differed between FH+ and FH- groups. The results revealed that women with family histories of breast cancer had a higher rate of epinephrine excretion while at work (p<0.005). In addition, women in the FH+ group were also more reactive to the stress of work, showing a greater percentage of increase in both epinephrine and norepinephrine from sleep to work (p<0.05). The results also indicated that the chronic stress effects associated with a family history of breast cancer were moderated by BMI, such that their impact was more pronounced and apparent when women were not obese. These findings support the idea that the heightened neuroendocrine reactivity to experimental stressors in women at familial risk of breast cancer also occurs when women encounter stressors in ordinary life (work stress). Additional research to explore the health consequences of increased reactivity in women at familial risk of breast cancer, and perhaps in individuals at familial risk of other life-threatening disease, would appear warranted.

Applying latent growth curve modeling to the investigation of individual differences in cardiovascular recovery from stress

OBJECTIVE

This paper provides an introduction to latent growth curve (LGC) modeling, a modern method for analyzing data resulting from change processes such as cardiovascular recovery from stress. LGC models are superior to traditional approaches such as repeated measures analysis of variance and simple change scores.

METHODS

The basic principles of LGC modeling are introduced and applied to data from 167 men and women whose systolic blood pressure was assessed before, during, and after the cold pressor and evaluated speech stressors and who had completed the Cook-Medley Hostility Inventory.

RESULTS

The LGC models revealed that systolic blood pressure recovery follows a different nonlinear trajectory after speech relative to the cold pressor. The difference resulted not from the initial decline at the completion of the stressor, but from higher levels at the end of the stressor and slower rate of change in decline for the speech. Hostility predicted the trajectory for speech but not for cold pressor. This relationship did not differ as a function of gender, although men had larger systolic blood pressure responses than women to both stressors.

CONCLUSIONS

LGC modeling yields an understanding of the processes and predictors of change that is not attainable through traditional statistical methods. Although our application concerns cardiovascular recovery from stress, LGC modeling has many other potential applications in psychosomatic research.

Idiodynamic profiles of cardiovascular activity: A P-technique approach

A study was conducted to expand the conventional view of cardiovascular (CV) reactivity by using the idiodynamic paradigm for investigation of individuals. Patterns of autonomic CV regulation were assessed in six subjects across diverse laboratory tasks on three separate occasions. Individual CV profiles were derived from these data with P-technique factor analysis, and then group aggregated with chain P-technique. The composite pattern suggested a three-component solution consisting of cardiac rate, cardiac contractility, and peripheral resistance factors. Individual profiles were compared to the composite pattern; these profiles differed in the number of components derived, percentage variance explained by these components, and relative dominance of specific CV components. A hypothesis that emerged is that the subjects differed in the complexity of CV control. It appears that the idiodynamic framework, combined with novel research designs and statistical methods, may help expand the view of CV reactivity beyond the traditional unitary view as response magnitude.