Cognitive stress and cardiovascular reactivity. I. Relationship to hypertension.

This report reviews the current literature relating cognitive stress and cardiovascular reactivity to the development of hypertension. Cardiovascular reactivity may refer to a change in one or several cardiovascular parameters as a function of exposure to a cognitive stressor, e.g., systolic BP, HR, etc. The cognitive stressors involve laboratory-based mental tasks such as mental mathematics, choice reaction time, and stressful interviews. The current findings suggest that the reactivity literature may have something unique to contribute to the study of hypertension. Prospective studies linking clinical hypertension to early reactivity are few in number. However, reactivity appears to be reliable within individuals over short periods of time (3 months), and individuals at the upper end of the reactivity distribution may have a higher incidence of future hypertension than those at the lower end. Reactivity may also contribute to two other dimensions of hypertension. Subjects with positive family histories of hypertension may be expected to be among the most reactive to cognitive stress, and among established hypertensive individuals, the reactivity to stress may be correlated with casual BP lability. Several avenues have been suggested through which a hyperresponsiveness to mental stress may be implicated in the development of hypertension. Repeated stressor episodes might influence vascular rigidity, through direct alteration of smooth muscle morphology and downregulation of the alpha receptor or through a process of autoregulation of CO, blood volume, and changes in renal regulation of water and sodium balance.