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(Stroke. 2004;35:1294.)
© 2004 American Heart Association, Inc.

Original Contributions

Stress-Induced Blood Pressure Reactivity and Silent Cerebrovascular Disease

Shari R. Waldstein, PhD; Eliot L. Siegel, MD; David Lefkowitz, MD; Karl J. Maier, PhD; Jessica R. Pelletier Brown, BA; Abraham M. Obuchowski, MD Leslie I. Katzel, MD, PhD

From the Department of Psychology (S.R.W., K.J.M., J.R.P.B.), University of Maryland, Baltimore County; Division of Gerontology, Department of Medicine (S.R.W., L.I.K.), and Department of Diagnostic Radiology (E.L.S., D.L., A.M.O.), University of Maryland, School of Medicine; and Geriatric Research Education and Clinical Center (S.R.W., L.I.K.), and Department of Diagnostic Radiology (E.L.S.), Baltimore Veterans Affairs Medical Center, Baltimore, MD.

Correspondence to Dr Shari R. Waldstein, Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. E-mail waldstei{at}umbc.edu

Background and Purpose— Exaggerated blood pressure (BP) responses to mental stress, an index of autonomic dysregulation, have been related to enhanced risk for stroke. This study examined cross-sectional relations of stress-induced BP reactivity to silent cerebrovascular disease assessed by magnetic resonance imaging (MRI) in healthy older adults.

Methods— Sixty-seven nondemented, community-dwelling older adults (ages 55 to 81; 75% male) free of major medical, neurological, or psychiatric disease, engaged in: (1) clinical assessment of resting systolic and diastolic BP; (2) assessment of systolic and diastolic BP responses to 3 laboratory-based mental stressors; and (3) MRI. MRIs were rated for small silent infarcts (3 mm), infarct-like lesions (<3 mm), and periventricular and deep white matter hyperintensities (WMH).

Results— After adjustment for age, gender, resting clinic BP, and fasting glucose levels, higher systolic BP reactivity was associated with an increased number of small silent infarcts (r²=0.14; P=0.004) and greater severity ratings of periventricular (r²=0.08; P<0.04) and deep WMH (r²=0.06; P<0.05). Higher diastolic BP reactivity was similarly associated with an increased number of small silent infarcts (r²=0.08; P<0.04), and greater severity ratings of periventricular (r²=0.08; P<0.04) and deep WMH (r²=0.11; P=0.009).

Conclusions— These results indicate that greater stress-induced BP reactivity is associated with enhanced silent cerebrovascular disease on MRI in healthy asymptomatic older adults independent of resting BP levels. Exaggerated stress-induced BP reactivity warrants further examination as a potential biobehavioral risk factor for cerebrovascular disease.

Key Words: blood pressure • cerebrovascular disorders • magnetic resonance imaging • stress

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