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Title: Blood pressure reactivity to psychological stress is associated with clinical outcomes in patients with heart failure
Authors: Sherwood, Andrew
Hill, LaBarron K.
Blumenthal, James A.
Adams, Kirkwood F.
Paine, Nicola J.
Koch, Gary G.
O'Connor, Christopher M.
Johnson, Kristy S.
Hinderliter, Alan L.
Issue Date: 2017
Publisher: © Elsevier
Citation: SHERWOOD, A. ...et al., 2017. Blood pressure reactivity to psychological stress is associated with clinical outcomes in patients with heart failure. American Heart Journal, 191, pp. 82-90.
Abstract: © 2017 Elsevier Inc. Introduction: Cardiovascular (CV) reactivity to psychological stress has been implicated in the development and exacerbation of cardiovascular disease (CVD). Although high CV reactivity traditionally is thought to convey greater risk of CVD, the relationship between reactivity and clinical outcomes is inconsistent and may depend on the patient population under investigation. The present study examined CV reactivity in patients with heart failure (HF) and its potential association with long-term clinical outcomes. Methods: One hundred ninety-nine outpatients diagnosed with HF, with ejection fraction ≤40%, underwent an evaluation of blood pressure (BP) and heart rate reactivity to a laboratory-based simulated public-speaking stressor. Cox proportional hazards regression models were used to examine the prospective association between BP and heart rate reactivity on a combined end point of death or CV hospitalization over a 5-year median follow-up period. Results: Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity, quantified as continuous variables, were inversely related to risk of death or CV hospitalization (Ps < .01) after controlling for established risk factors, including HF disease severity and etiology. In similar models, heart rate reactivity was unrelated to outcome (P = .12). In models with tertiles of reactivity, high SBP reactivity, compared with intermediate SBP reactivity, was associated with lower risk (hazard ratio [HR] = .498, 95% CI .335-.742, P =.001), whereas low SBP reactivity did not differ from intermediate reactivity. For DBP, high reactivity was marginally associated with lower risk compared with intermediate DBP reactivity (HR = .767, 95% CI .515-1.14, P =.193), whereas low DBP reactivity was associated with greater risk (HR = 1.49, 95% CI 1.027-2.155, P =.0359). No relationship of heart rate reactivity to outcome was identified. Conclusions: For HF patients with reduced ejection fraction, a robust increase in BP evoked by a laboratory-based psychological challenge was associated with lower risk for adverse CVD events and may be a novel and unique marker of left ventricular systolic reserve that is accompanied by a more favorable long-term prognosis.
Description: This paper was published in the journal American Heart Journal and the definitive published version is available at https://doi.org/10.1016/j.ahj.2017.07.003.
Sponsor: This study was supported by Grants HL61784 and HL121708 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, and grant M01-RR-30 from the General Clinical Research Center program, National Center for Research Resources, National Institutes of Health.
Version: Accepted for publication
DOI: 10.1016/j.ahj.2017.07.003
URI: https://dspace.lboro.ac.uk/2134/26502
Publisher Link: https://doi.org/10.1016/j.ahj.2017.07.003
ISSN: 1097-6744
Appears in Collections:Published Articles (Sport, Exercise and Health Sciences)

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