Hypertension, Vol 14, 524-530, Copyright © 1989 by American Heart Association
MS Menkes, KA Matthews, DS Krantz, U Lundberg, LA Mead, B Qaqish, KY Liang, CB Thomas and TA Pearson
Cardiovascular reactivity to stress is hypothesized to be a marker for
subsequent neurogenic cardiovascular disease, but few prospective studies
of this hypothesis are available. We studied 910 white male medical
students who had their blood pressure and pulse rate measured before and
during a cold pressor test in the years 1948-1964. Hypertensive status
(requiring drug treatment) was ascertained by annual questionnaires in the
20- to 36-year follow-up period. An association was observed between
maximum change in systolic blood pressure and later hypertension, with a
cumulative incidence of hypertension by age 44 of 6.7%, 3.0%, and 2.4% for
a change in systolic blood pressure in the upper, middle two, and lowest
quartiles, respectively (Kaplan-Meier, p less than 0.02). After adjustment
for study entry age, Quetelet Index, cigarette smoking, pretest systolic
blood pressure, and paternal or maternal history of hypertension in a Cox
model, the association persisted. The excess risk associated with systolic
blood pressure reactivity was not apparent until the population aged some
20 years and was most apparent among those in whom hypertension developed
before age 45 (relative risk = 2.5, 95% confidence intervals = 1.47, 4.71
for a 20 mm Hg change). Diastolic blood pressure and heart rate changes
were not associated with later hypertension. These data suggest that
persons prone to later hypertension manifest an altered physiology at a
young age.
ARTICLES
Cardiovascular reactivity to the cold pressor test as a predictor of hypertension
Johns Hopkins Medical Institution, Baltimore, Maryland.
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