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(Hypertension. 1995;25:384-390.)
© 1995 American Heart Association, Inc.

Articles

Physiological Determinants of Hyperreactivity to Stress in Borderline Hypertension

Andrew Sherwood; Alan L. Hinderliter; Kathleen C. Light

From Duke University Medical Center, Department of Psychiatry and Behavioral Sciences (A.S.), Durham, NC, and the University of North Carolina, Departments of Medicine (A.L.H.) and Psychiatry (K.C.L.), Chapel Hill.

Correspondence to Andrew Sherwood, Box 3119, Duke University Medical Center, Durham, NC 27710.

Abstract Blood pressure hyperreactivity during stress is characteristic of borderline hypertension in white men. The present study evaluated the hemodynamic basis of this hyperreactivity and assessed its physiological basis in terms of sympathetic nervous system function. Cardiovascular adjustments to an aversive reaction time test were compared with those of the forehead cold pressor test, representing stressors that elicit active behavioral responses in contrast to passive tolerance of aversive stimulation. As anticipated, blood pressure increases were greater in 12 borderline hypertensive men compared with 21 age-matched normotensive men during the active reaction time stressor but not during the passive cold pressor test. The pressor hyperreactivity in borderline hypertensives was associated with excessive rises in plasma epinephrine and norepinephrine, leading to greater increases in cardiac output, despite evidence that the cardiac ß-adrenergic receptors in these subjects were downregulated compared with those of normotensive subjects. During the cold pressor test, borderline hypertension was associated with greater increases in systemic vascular resistance, which, in the presence of normal baroreceptor reflex function, led to an attenuation of cardiac output, thus producing no greater net effect on blood pressure than seen in normotensive subjects. Evidence of vascular hypertrophy in the borderline hypertensive subjects was considered to account for their vascular hyperreactivity to cold pressor stimulation. Collectively, the observations in this study further support the view that the early stages of hypertension in white men are characterized by sympathetic nervous system hyperreactivity, but only in association with tasks that elicit active behavioral coping responses. The extent to which these responses are elicited by typical daily events may be an important determinant of whether borderline hypertension matures to its established form, which displays hemodynamic characteristics dominated by vascular structural changes.

Key Words: hypertension, borderline • receptors, adrenergic • stress • blood pressure • cardiac output • vascular resistance • catecholamines

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