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(Hypertension. 2002;39:184.)
© 2002 American Heart Association, Inc.

Scientific Contributions

Hemodynamic and Autonomic Adjustments to Real Life Stress Conditions in Humans

Daniela Lucini; Guido Norbiato; Mario Clerici; Massimo Pagani

From Centro di Ricerca sulla Terapia Neurovegetativa, Medicina Interna I, Ospedale L. Sacco, Centro Ricerche Cardiovascolari, CNR, Istituto Scienze Biomediche, University of Milano (D.L., M.P.), Milano; Department of Psychology, University of Urbino (D.L.), Urbino; Department of Endocrinology, Ospedale L. Sacco (G.N.), Milano; and Chair of Immunology, DiSP LITA Vialba, University of Milano (M.C.), Milano, Italy

Correspondence to Massimo Pagani, MD, FACC, Medicina I, Ospedale L. Sacco, Università di Milano, ViaG.B. Grassi, 74, 20157 Milano, Italy. E-mail massimop{at}fisiopat.sacco.unimi.it

Psychological stress represents a risk factor for hypertension, but mechanisms are not known in detail. In this investigation we tested the hypothesis that real-life stress conditions produce changes in autonomic cardiac and vascular regulation that might differ in magnitude. University students, a well-established model of mild real-life stress, were examined shortly before a university examination, and a second time 3 months afterward, during holiday. Autonomic cardiovascular regulation was assessed by a noninvasive approach, based on autoregressive analysis of RR interval variability (V) and of systolic arterial pressure (SAP) V. The overall level of stress in the two sessions was gauged from the elevated salivary cortisol (5.6±0.5 versus 2.4±0.2 ng/mL, P<0.05) and altered cytokine profile (P<0.05). During the stress day, the RR interval was reduced and arterial pressure increased significantly; simultaneously, the normalized low frequency component of RRV (a marker of sympathetic modulation of the sinoatrial node) was increased and the index (a measure of baroreflex gain) reduced. Concomitantly, the autonomic response to the sympathetic excitation produced by standing was altered: cardiac response was impaired and vascular responsiveness increased. Markers of autonomic regulation of the sinoatrial node correlated significantly with cortisol levels, both at rest and also considering standing induced changes, suggesting a gradual range of effects. The data support the concept that mild real-life stress increases arterial pressure and impairs cardiovascular homeostasis. These changes, assessable with spectral analysis of cardiovascular variability, might contribute, in susceptible individuals, to the link between psychological stress and increased cardiovascular risk of hypertension.

Key Words: autonomic nervous system • baroreceptors • stress hormones • risk factors

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