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.

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.

Interspecies hormonal interactions between man and the domestic dog (Canis familiaris)

To date, hormonal influence in interspecies interaction has not been examined. In a study of a dog agility competition among human/dog teams, men's pre-competition basal testosterone (T) levels were positively related to changes in dogs' cortisol levels from pre- to post-competition, but only among losing teams. Furthermore, pre-competition basal T in men on losing teams predicted more than half of the variance in dogs' cortisol change. This relationship was mediated through men's punitive and affiliative behaviors towards their dogs immediately after competition. Men's T change was also a significant predictor of dogs' change in cortisol such that men who experienced greater decreases in T after a loss were associated with dogs that experienced greater increases in cortisol. In winning teams, men's pre-competition T and T changes were unrelated to dogs' cortisol changes. These results are discussed in light of T as a proxy for dominance motivation as well as T's relation to stress across the species boundary.

Social support versus social evaluation: unique effects on vascular and myocardial response patterns

OBJECTIVES

This study examined the effects of companion presence and evaluation on cardiovascular reactivity to an acute stressor.

METHODS

Eighty-two women completed a speech task in one of four conditions: with an evaluative companion present, with a nonevaluative companion present, alone while being evaluated by a companion with a video camera, or alone while the companion waited outside.

RESULTS

A significant interaction between companion condition and evaluative condition on systolic blood pressure was found; women who were evaluated while alone demonstrated significantly greater reactivity than did women who were in the nonevaluative alone condition. Furthermore, both potential for evaluation and the presence of a companion had important influences on hemodynamic parameters underlying the blood pressure response. Specifically, those in evaluative conditions showed greater myocardial responding than those in nonevaluative conditions and those in alone conditions showed greater vascular responding than did those with companions present. Taken together, those in the evaluative alone condition demonstrated systolic blood pressure responses reflecting both myocardial and vascular contributions.

CONCLUSIONS

Social support and social evaluation have unique effects on vascular and myocardial responding. The implications for future research include focus on the stress-buffering model of social support and the value of including impedance cardiography measures in investigations of cardiovascular functioning.

Increases in lipids and immune cells in response to exercise and mental stress in patients with suspected coronary artery disease: effects of adjustment for shifts in plasma volume

This study examined the role of shifts in plasma volume on lipid and immune reactions to stress. Lipid, immune, rheological, and cardiovascular reactions to exercise and mental stress in 51 patients with suspected coronary artery disease were determined. Blood pressure and heart rate were measured during and blood samples taken at the end of each rest and task. Lipids (total cholesterol, triglycerides, HDL, LDL) and immune cells (lymphocytes, monocytes, granulocytes) increased with exercise, whereas cholesterol, LDL, and lymphocytes increased with mental stress. Plasma volume decreased by 1 and 5% following mental and exercise stress, respectively. The task-induced increases in lipids were no longer statistically significant following adjustment for changes in plasma volume, whereas the increases in immune cell numbers survived such correction. This study provides evidence that, in coronary artery disease patients, exercise and mental stress-induced increases in lipids but not immune cells can be largely accounted for by shifts in plasma volume.