Nina Kupper1, Johan Denollet2, Jos Widdershoven3, Willem J Kop2. 1. Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands. Electronic address: h.m.kupper@tilburguniversity.edu. 2. Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands. 3. Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Department of Cardiology, TweeSteden Hospital, Tilburg, the Netherlands.
Abstract
OBJECTIVES: This study examined whether blood pressure (BP) and heart rate responses to acute mental stress were associated with mortality in patients with heart failure (HF). BACKGROUND: HF is characterized by reduced contractility and impaired BP reactivity. Compared to exercise-induced physiological changes, the effects of mental stress on BP and heart rate in HF are not well understood. METHODS: Patients with systolic HF (N = 100, 26% female, mean 65 ± 12 years of age) underwent a structured public speech task, during which BP and heart rate were recorded. Stress-induced BP and heart rate reactivity were categorized as high (>75%), intermediate (25% to 75%), or low (<25%). Cox proportional hazards regressions were used to examine the predictive value of cardiovascular stress responses for mortality (median follow-up = 48.5 months), adjusting for age, implanted devices, and baseline BP and heart rate levels. RESULTS: At follow-up, 31 patients had died (31%). Mortality rates were 2 times higher (hazard ratio [HR]: 2.04; 95% confidence interval [CI]: 1.15 to 3.60; p = 0.014) among patients with the lowest diastolic BP responses (mean = -2.4 ± 5.4 mm Hg) to mental stress than among those patients with an intermediate diastolic BP response (mean = 7.3 ± 2.5 mm Hg), adjusting for covariates. High diastolic BP reactivity (mean = 16.3 ± 3.4 mm Hg) was not related to mortality (HR: 0.95; 95% CI: 0.55 to 1.66). Systolic BP responses showed a similar but nonsignificant association. Multivariate analyses showed that a high heart rate response (>6.3 beats/min) to acute mental stress was associated with a reduced mortality risk (HR: 0.40; 95% CI: 0.16 to 1.00; p = 0.051) compared to patients with intermediate responses. CONCLUSIONS: Low diastolic BP reactivity to mental stress is independently associated with all-cause mortality in patients with HF. Larger studies need to replicate this finding and examine the role of psychosocial variables.
OBJECTIVES: This study examined whether blood pressure (BP) and heart rate responses to acute mental stress were associated with mortality in patients with heart failure (HF). BACKGROUND: HF is characterized by reduced contractility and impaired BP reactivity. Compared to exercise-induced physiological changes, the effects of mental stress on BP and heart rate in HF are not well understood. METHODS:Patients with systolic HF (N = 100, 26% female, mean 65 ± 12 years of age) underwent a structured public speech task, during which BP and heart rate were recorded. Stress-induced BP and heart rate reactivity were categorized as high (>75%), intermediate (25% to 75%), or low (<25%). Cox proportional hazards regressions were used to examine the predictive value of cardiovascular stress responses for mortality (median follow-up = 48.5 months), adjusting for age, implanted devices, and baseline BP and heart rate levels. RESULTS: At follow-up, 31 patients had died (31%). Mortality rates were 2 times higher (hazard ratio [HR]: 2.04; 95% confidence interval [CI]: 1.15 to 3.60; p = 0.014) among patients with the lowest diastolic BP responses (mean = -2.4 ± 5.4 mm Hg) to mental stress than among those patients with an intermediate diastolic BP response (mean = 7.3 ± 2.5 mm Hg), adjusting for covariates. High diastolic BP reactivity (mean = 16.3 ± 3.4 mm Hg) was not related to mortality (HR: 0.95; 95% CI: 0.55 to 1.66). Systolic BP responses showed a similar but nonsignificant association. Multivariate analyses showed that a high heart rate response (>6.3 beats/min) to acute mental stress was associated with a reduced mortality risk (HR: 0.40; 95% CI: 0.16 to 1.00; p = 0.051) compared to patients with intermediate responses. CONCLUSIONS: Low diastolic BP reactivity to mental stress is independently associated with all-cause mortality in patients with HF. Larger studies need to replicate this finding and examine the role of psychosocial variables.
Authors: Stephan von Haehling; Christoph Birner; Elke Dworatzek; Stefan Frantz; Kristian Hellenkamp; Carsten W Israel; Tibor Kempf; Hermann H Klein; Christoph Knosalla; Ulrich Laufs; Philip Raake; Rolf Wachter; Gerd Hasenfuss Journal: Nat Rev Cardiol Date: 2022-01-06 Impact factor: 49.421
Authors: Andrew Sherwood; LaBarron K Hill; James A Blumenthal; Kirkwood F Adams; Nicola J Paine; Gary G Koch; Christopher M O'Connor; Kristy S Johnson; Alan L Hinderliter Journal: Am Heart J Date: 2017-07-12 Impact factor: 4.749
Authors: Kanokwan Bunsawat; Stephen M Ratchford; Jeremy K Alpenglow; John J Ryan; Russell S Richardson; D Walter Wray Journal: J Card Fail Date: 2020-11-06 Impact factor: 5.712
Authors: Thomas Wyss; Maria Boesch; Lilian Roos; Céline Tschopp; Klaus M Frei; Hubert Annen; Roberto La Marca Journal: Sports Med Open Date: 2016-08-23
Authors: Judith L Meadows; Samit Shah; Matthew M Burg; Steven Pfau; Robert Soufer Journal: Circ Cardiovasc Imaging Date: 2020-08-07 Impact factor: 8.589