In the Journals

Low BP response to mental stress associated with mortality in patients with HF

In patients with HF, low diastolic BP reactivity to acute mental stress was associated with all-cause mortality, according to a new study.

Researchers investigated the effects of mental stress on BP and heart rate in 100 patients with systolic HF (left ventricular ejection fraction < 40%; mean age, 65 years; 26% women) who underwent a structured public speech task during which BP and heart rate were recorded. Patients were stratified by stress-induced BP and heart rate reactivity and divided into quartiles. The lowest quartile (mean systolic BP change, 1 mm Hg; mean diastolic BP change, -2.4 mm Hg; mean heart rate change, -1.6 beats/minute) were defined as low responders, the highest quartile (mean systolic BP change, 30.3 mm Hg; mean diastolic BP change, 16.3 mm Hg; mean heart rate change, 9.4 beats/minute) were defined as high responders and the middle two quartiles were defined as intermediate responders.

During a median follow-up of 48.5 months, 31% of patients died, Nina Kupper, PhD, and colleagues found.

Response and mortality

After adjustment for age, implanted devices, baseline BP and baseline heart rate, mortality rates were twice as high (HR = 2.04; 95% CI, 1.15-3.6) in patients with the lowest diastolic BP responses to mental stress (mean change in diastolic BP, -2.4 mm Hg) compared with patients with intermediate responses (mean change in diastolic BP, 7.3 mm Hg).

However, patients with high diastolic BP reactivity (mean change, 16.3 mm Hg) did not have an elevated risk for mortality compared with those with intermediate responses (HR = 0.95; 95% CI, 0.55-1.66).

Systolic BP responses showed a similar pattern but were not statistically significant, according to the researchers.

The quartile with the highest heart rate response (HR = 0.4; 95% CI, 0.16-1) and the quartile with the lowest heart rate response (HR = 0.28; 95% CI, 0.09-0.87) both displayed a decreased mortality risk compared with those with an intermediate heart rate response. However, higher baseline heart rate was a predictor of mortality (HR = 1.04; 95% CI, 1.003-1.07), the researchers wrote.

“This study suggests that blunted reactivity to acute mental stress might add to the risk stratification of HF patients and expands the knowledge base about the biobehavioral mechanics involved in HF progression,” Kupper, from the Center of Research on Psychology in Somatic Diseases, department of medical and clinical psychology, Tilburg University, the Netherlands, and colleagues wrote. “Clinically, these results suggest that suboptimal pressor responses to acute psychosocial stressors are a prognostic factor in HF.”

High response may be protective

C. Noel Bairey Merz, MD, FACC, FAHA

C. Noel Bairey Merz

In a related editorial, C. Noel Bairey Merz, MD, FACC, FAHA; Omeed Elboudwarej, MD; and Puja Mehta, MD, from the Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, wrote that this study is consistent with previous research that demonstrated “a predictable, direct relationship between the R-R interval and BP response, such that higher BP response is associated with the slowing of the [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.” - by Erik Swain

Disclosure: The researchers and Elboudwarej report no relevant financial disclosures. Bairey Merz reports receiving consultant fees/honoraria from Gilead and Kaiser and serving on the speakers’ bureau for Practice Point Communications and Vox Media. Mehta reports receiving research support from Gilead.

In patients with HF, low diastolic BP reactivity to acute mental stress was associated with all-cause mortality, according to a new study.

Researchers investigated the effects of mental stress on BP and heart rate in 100 patients with systolic HF (left ventricular ejection fraction < 40%; mean age, 65 years; 26% women) who underwent a structured public speech task during which BP and heart rate were recorded. Patients were stratified by stress-induced BP and heart rate reactivity and divided into quartiles. The lowest quartile (mean systolic BP change, 1 mm Hg; mean diastolic BP change, -2.4 mm Hg; mean heart rate change, -1.6 beats/minute) were defined as low responders, the highest quartile (mean systolic BP change, 30.3 mm Hg; mean diastolic BP change, 16.3 mm Hg; mean heart rate change, 9.4 beats/minute) were defined as high responders and the middle two quartiles were defined as intermediate responders.

During a median follow-up of 48.5 months, 31% of patients died, Nina Kupper, PhD, and colleagues found.

Response and mortality

After adjustment for age, implanted devices, baseline BP and baseline heart rate, mortality rates were twice as high (HR = 2.04; 95% CI, 1.15-3.6) in patients with the lowest diastolic BP responses to mental stress (mean change in diastolic BP, -2.4 mm Hg) compared with patients with intermediate responses (mean change in diastolic BP, 7.3 mm Hg).

However, patients with high diastolic BP reactivity (mean change, 16.3 mm Hg) did not have an elevated risk for mortality compared with those with intermediate responses (HR = 0.95; 95% CI, 0.55-1.66).

Systolic BP responses showed a similar pattern but were not statistically significant, according to the researchers.

The quartile with the highest heart rate response (HR = 0.4; 95% CI, 0.16-1) and the quartile with the lowest heart rate response (HR = 0.28; 95% CI, 0.09-0.87) both displayed a decreased mortality risk compared with those with an intermediate heart rate response. However, higher baseline heart rate was a predictor of mortality (HR = 1.04; 95% CI, 1.003-1.07), the researchers wrote.

“This study suggests that blunted reactivity to acute mental stress might add to the risk stratification of HF patients and expands the knowledge base about the biobehavioral mechanics involved in HF progression,” Kupper, from the Center of Research on Psychology in Somatic Diseases, department of medical and clinical psychology, Tilburg University, the Netherlands, and colleagues wrote. “Clinically, these results suggest that suboptimal pressor responses to acute psychosocial stressors are a prognostic factor in HF.”

High response may be protective

C. Noel Bairey Merz, MD, FACC, FAHA

C. Noel Bairey Merz

In a related editorial, C. Noel Bairey Merz, MD, FACC, FAHA; Omeed Elboudwarej, MD; and Puja Mehta, MD, from the Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, wrote that this study is consistent with previous research that demonstrated “a predictable, direct relationship between the R-R interval and BP response, such that higher BP response is associated with the slowing of the [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.” - by Erik Swain

Disclosure: The researchers and Elboudwarej report no relevant financial disclosures. Bairey Merz reports receiving consultant fees/honoraria from Gilead and Kaiser and serving on the speakers’ bureau for Practice Point Communications and Vox Media. Mehta reports receiving research support from Gilead.