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(Hypertension. 2002;40:742.)
© 2002 American Heart Association, Inc.

Scientific Contributions

Is Cardiovascular Reactivity Associated With Atherosclerosis Among Hypertensives?

Peter J. Gianaros; Maria E. Bleil; Matthew F. Muldoon; J. Richard Jennings; Kim Sutton-Tyrrell; Jeanne M. McCaffery; Stephen B. Manuck

From the Cardiovascular Behavioral Medicine Research Program (P.J.G.), Department of Psychology (M.E.B., S.B.M.), Department of Medicine (M.F.M.), Departments of Psychiatry and Psychology (J.R.J.), and Department of Epidemiology (K.S.-T.), University of Pittsburgh, Pennsylvania; and Department of Psychiatry (J.M.M.), Brown University, Providence, RI.

Correspondence to Peter J. Gianaros, PhD, E1329 Western Psychiatric Institute and Clinic, 3811 O’Hara St, Pittsburgh, PA 15213. E-mail gianarospj{at}msx.upmc.edu

Exaggerated cardiovascular reactivity to behavioral challenges among otherwise healthy individuals has been associated with carotid atherosclerosis. We evaluated whether a similar relationship exists among hypertensives, who are at a heightened atherosclerotic risk. Untreated, hypertensive men (n=251; age range, 40 to 70 years; 197 white, 54 black) completed a standardized battery of behavioral challenges while their blood pressure responses to the battery were measured. Mean and maximum carotid intima-media thickness and the occurrence of carotid plaques were subsequently determined using B-mode ultrasonography. Although greater systolic and diastolic responses to the battery were associated with greater mean and maximum intima-media thickness in univariate analyses (P<0.01), only diastolic reactivity showed a unique association with mean and maximum carotid intima-media thickness after multivariate adjustment for age, race, socioeconomic status, smoking and alcohol use, body mass index, lipid profile, glucose and insulin concentrations, and resting blood pressure (P<0.05). Carotid plaque occurrence was associated with greater systolic reactivity (P=0.05) and was marginally associated with greater diastolic reactivity (P=0.07) in univariate analyses, but neither systolic nor diastolic reactivity was uniquely associated with the presence of carotid plaques after multivariate risk-factor adjustment. Among hypertensives, exaggerated behaviorally evoked cardiovascular reactivity appears to be uniquely associated with greater carotid intima-media thickness but not with carotid plaque occurrence.

Key Words: atherosclerosis • cardiovascular reactivity • carotid intima-media thickness • carotid plaque • stress

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