Cardiovascular reactivity in cardiovascular disease: "once more unto the breach".

Discussed here are conceptual and methodologic issues that bear on the role of behaviorally evoked cardiovascular reactivity in cardiovascular disease. It is argued that recent criticisms concerning the validity of cardiovascular reactivity as a stable dimension of individual differences arise from inadequacies of measurement prevalent in prior literature. With standardization of test stimuli and application of psychometric principles lo protocol development, assessment of reactivity are found to be highly reliable and, in turn, to demonstrate the dispositional nature of this construct. Recent studies also document an underlying heterogeneity of hemodynamic reactions to stress, with distinct cardiac and vascular components. Because hemodynamic adjustments show some plasticity under differing task conditions, responses seen in particular contexts reflect influences of both an individual-specific response potential and response-eliciting properties of the stimulus. On the question of disease relevance, it is concluded that cardiovascular reactivity cannot yet be considered an established risk factor for either coronary heart disease or hypertension. However, the preponderance of existing clinical, experimental. and epidemiologic evidence is consistent with such an association and warrants further study in the context or population-based, prospective investigation.