Reduced BP When Stressed May Signal Higher Mortality Risk in HF Patients

Chronic heart failure (HF) patients who show a reduction in diastolic blood pressure (BP) in response to mental stress may have an increased risk of earlier death, according to a study published May 4 in JACC: Heart Failure.

The study, led by Nina Kupper, PhD, from the Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands, looked at 100 patients with systolic HF (26 percent female, mean 65 ± 12 years of age) who had their BP and heart rate recorded while they performed a three-minute public speech. Subjects were told their performances were being rated. Stress-induced BP and heart rate reactivity were categorized as high (>75 percent), intermediate (25 percent or 75 percent) or low (<25 percent). Mortality and cause of death were obtained until 78 months after the mental-stress tests and cause of death was recorded as cardiac or noncardiac.

Results showed that patients who showed either a high or low heart rate in response to stress had a decreased mortality rate compared to those in the intermediate group. Those with a higher heart rate response were more likely to die of cardiac causes than those with a lower heart rate. Lower or even negative diastolic BP reactivity to mental stress was independently associated with a higher mortality risk over the follow-up period when compared to higher reactivity. The same increased risk was not found for systolic BP. Subjects with lower diastolic BP were younger and slightly unhealthier. They also had lower levels of depression and negative affectivity.

The researchers conclude that these reactions to stress are a prognostic factor and may add to the clinical risk profile of HF patients. They add that moving forward, future research is needed to determine whether this reaction in BP predicts HF progression is independent of psychological variables such as depression and personality factors. To that end, future trials should target both behavioral and pharmacological approaches to reach desirable BP reactivity to stress.

“[These findings] further demonstrate the complex balancing act that autonomic nervous system plays in cardiovascular health and disease,” said C. Noel Bairey Merz, MD, FACC, et al. in an accompanying editorial comment. They explain that previous studies have demonstrated that a higher BP response is associated with a slowing heart rate. “The current study results suggest that this anticipated response, consistent with an intact cardiac autonomic nervous system, in the setting of HF may be protective,” they add.  

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension, Stress

Keywords: Autonomic Nervous System, Blood Pressure, Cause of Death, Depression, Exercise Test, Follow-Up Studies, Heart Failure, Heart Rate, Hypertension, Netherlands, Personality, Psychology, Clinical, Stress, Psychological


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