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(Stroke. 2001;32:1263.)
© 2001 American Heart Association, Inc.
Original Contributions |
Stress-Induced Blood Pressure Reactivity and Incident Stroke in Middle-Aged Men
Presented in part at the 57th Annual Scientific Meeting of the American Psychosomatic Society, Vancouver, British Columbia, Canada, March 17–20, 1999, and published in abstract form (Psychosom Med. 1999;61:125).
From the Department of Epidemiology, University of Michigan, Ann Arbor (S.A.E., J.W.L., G.A.K.); Research Institute of Public Health and Department of Community Health and General Practice, University of Kuopio (Finland) (T.A.L., J.T.S.); and Department of Neurology, University of Kuopio, and Brain Research and Rehabilitation Center, Neuron, Kuopio, Finland (J.S.).
Correspondence to Susan A. Everson, PhD, MPH, Department of Epidemiology, University of Michigan School of Public Health, 109 S Observatory St, Ann Arbor, MI 48109-2029. E-mail severson{at}umich.edu
Background and Purpose—Exaggerated blood pressure reactivity to stress is associated with atherosclerosis and hypertension, which are known stroke risk factors, but its relation to stroke is unknown. Previous work also indicates that the association between reactivity and cardiovascular diseases may be influenced by socioeconomic status.
Methods—The impact of blood pressure reactivity and socioeconomic status on incident stroke was examined in 2303 men (mean age, 52.8±5.1 years) from a population-based, longitudinal study of risk factors for ischemic heart disease in eastern Finland. Reactivity was calculated as the difference between blood pressure measured during the anticipatory phase of an exercise tolerance test (before exercise) and resting blood pressure, measured 1 week earlier. Mean systolic reactivity was 20 mm Hg (±15.9), and mean diastolic reactivity was 8.6 mm Hg (±8.5). Socioeconomic status was assessed as years of education. One hundred thirteen incident strokes (90 ischemic) occurred in 11.2 (±1.6) years of follow-up.
Results—Men with
exaggerated systolic reactivity (
20 mm Hg) had 72%
greater risk of any stroke (relative hazard ratio [RH], 1.72; 95%
CI, 1.17 to 2.54) and 87% greater risk of ischemic
stroke (RH, 1.87; 95% CI, 1.20 to 2.89) relative to less reactive men.
Moreover, men who were high reactors and poorly educated were nearly 3
times more likely to suffer a stroke than better educated, less
reactive men (RH, 2.90; 95% CI, 1.66 to 5.08). Adjustment for stroke
risk factors had little impact on these associations.
Diastolic reactivity was unrelated to stroke
risk.
Conclusions—Excessive sympathetic reactivity to stress may be etiologically important in stroke, especially ischemic strokes, and low socioeconomic status confers added risk.
Editorial Comment
Something Old and Something New
Presented in part at the 57th Annual Scientific Meeting of the American Psychosomatic Society, Vancouver, British Columbia, Canada, March 17–20, 1999, and published in abstract form (Psychosom Med. 1999;61:125).
Department of Psychiatry, Epidemiology, and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
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