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Is cardiovascular reactivity associated with atherosclerosis among hypertensives?
Peter J Gianaros1, Maria E Bleil, Matthew F Muldoon
1Cardiovascular Behavioral Medicine Research Program, University of Pittsburgh, Pennsylvania, USA. gianarospj@msx.upmc.edu
Insights
Exaggerated blood pressure responses to stress in hypertensive men are linked to thicker carotid arteries. However, this heightened cardiovascular reactivity did not uniquely predict the presence of carotid plaques after accounting for other risk factors.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Atherosclerosis Studies
Background:
- Exaggerated cardiovascular reactivity is linked to carotid atherosclerosis in healthy individuals.
- Hypertensive individuals face elevated risks for atherosclerosis.
- This study investigates this association within a hypertensive cohort.
Purpose of the Study:
- To determine if exaggerated cardiovascular reactivity to behavioral challenges is associated with carotid atherosclerosis in untreated hypertensive men.
- To assess the relationship between blood pressure reactivity and carotid intima-media thickness and plaque occurrence.
Main Methods:
- 251 untreated hypertensive men (40-70 years) underwent behavioral challenges measuring blood pressure responses.
- Carotid intima-media thickness and plaque presence were assessed using B-mode ultrasonography.
- Statistical analyses included univariate and multivariate adjustments for various risk factors.
Main Results:
- Greater systolic and diastolic blood pressure reactivity correlated with increased carotid intima-media thickness in univariate analyses.
- Diastolic reactivity uniquely predicted greater mean and maximum carotid intima-media thickness after multivariate adjustment.
- Neither systolic nor diastolic reactivity uniquely predicted carotid plaque occurrence after risk-factor adjustment.
Conclusions:
- In hypertensive men, exaggerated cardiovascular reactivity is uniquely associated with increased carotid intima-media thickness.
- Behaviorally evoked cardiovascular reactivity does not appear to be an independent predictor of carotid plaque occurrence in this cohort.
Abstract:
Exaggerated cardiovascular reactivity to behavioral challenges among otherwise healthy individuals has been associated with carotid atherosclerosis. We evaluated whether a similar relationship exists among hypertensives, who are at a heightened atherosclerotic risk. Untreated, hypertensive men (n=251; age range, 40 to 70 years; 197 white, 54 black) completed a standardized battery of behavioral challenges while their blood pressure responses to the battery were measured. Mean and maximum carotid intima-media thickness and the occurrence of carotid plaques were subsequently determined using B-mode ultrasonography. Although greater systolic and diastolic responses to the battery were associated with greater mean and maximum intima-media thickness in univariate analyses (P<0.01), only diastolic reactivity showed a unique association with mean and maximum carotid intima-media thickness after multivariate adjustment for age, race, socioeconomic status, smoking and alcohol use, body mass index, lipid profile, glucose and insulin concentrations, and resting blood pressure (P<0.05). Carotid plaque occurrence was associated with greater systolic reactivity (P=0.05) and was marginally associated with greater diastolic reactivity (P=0.07) in univariate analyses, but neither systolic nor diastolic reactivity was uniquely associated with the presence of carotid plaques after multivariate risk-factor adjustment. Among hypertensives, exaggerated behaviorally evoked cardiovascular reactivity appears to be uniquely associated with greater carotid intima-media thickness but not with carotid plaque occurrence.