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(Stroke. 2001;32:1712.)
© 2001 American Heart Association, Inc.

Original Contributions

Adaptive Behavior in Stressful Situations and Stroke Incidence in Hypertensive Men

Results From Prospective Cohort Study "Men Born in 1914" in Malmö, Sweden

Lena André-Petersson, MS; Gunnar Engström, MD, PhD; Bo Hagberg, PhD; Lars Janzon, MD, PhD Gunilla Steen, MS

From the Division of Epidemiology, Department of Community Medicine (G.E., L.J.), Malmö University Hospital, Lund University, Malmö, Sweden; Department of Psychology (L.A.-P.), Lund University, Lund, Sweden; Gerontology Research Center (B.H.), Lund, Sweden; and Department of Geriatric Medicine (G.S.), Göteborg University, Göteborg, Sweden.

Correspondence to Lena André-Petersson, Gerontology Research Center, Karl XII gatan 1, S-222 20 Lund, Sweden. E-mail Lena.Andre-Petersson{at}psychology.lu.ses

Background and Purpose—— Although hypertension is a major risk factor for stroke, many hypertensive persons remain healthy. The aim of the present study was to analyze whether adaptation in a stressful situation was associated with the incidence of stroke in hypertensive men.

Methods—— Two hundred thirty-eight hypertensive men were followed from baseline in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation to stress was studied with the serial Color-Word Test. In the Regression dimension, 4 patterns of adaptation could be distinguished according to mastering of the test. Successful mastering of the test was shown in stabilized patterns, increasing difficulty in cumulative patterns, fluctuating difficulty in dissociative patterns, and fluctuating difficulty that increased during testing in cumulative-dissociative patterns. The patterns were compared regarding stroke incidence.

Results—— Forty-three men experienced a stroke during follow-up. Stroke rates per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for men with cumulative patterns, 16.2 for men with dissociative patterns, and 31.2 for men with cumulative-dissociative patterns. Multivariate analysis, adjusted for relevant cerebrovascular risk factors, showed that the cumulative-dissociative pattern of the Regression dimension was associated with an increased risk of stroke during follow-up (relative risk 3.00, 95% CI 1.32 to 6.81).

Conclusions—— The specific behavior pattern, characterized by the greatest difficulties in managing the test, was associated with incidence of stroke in hypertensive men. One interpretation is that hypertensive men who chronically fail to find successful strategies in stressful situations are vulnerable to the damaging effects of stress and thereby at an increased risk of a future stroke.

Editorial Comment

Results From Prospective Cohort Study "Men Born in 1914" in Malmö, Sweden

Deirdre A. Lane, PhD; Douglas Carroll, PhD; Gregory Y.H. Lip, MD Guest Editors

University Department of MedicineCity Hospital Birmingham, UK
School of Sport and Exercise Sciences University of Birmingham BirminghamUK

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