Steptoe Andrew, Marmot Michael
International Centre for Health and Society, Psychology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
J Hypertens. 2005 Mar;23(3):529-36. doi: 10.1097/01.hjh.0000160208.66405.a8.
To assess whether variation in the rate of cardiovascular recovery following exposure to acute psychological stress predicts changes in blood pressure longitudinally, independently of blood pressure at baseline and other covariates.
A 3-year longitudinal study.
A total of 209 men and women aged 45-59 years at baseline, with no history of cardiovascular disease including hypertension.
Measurement of blood pressure, heart rate, heart rate variability, cardiac index and total peripheral resistance at rest, during two moderately stressful behavioural tasks and up to 45 min post-stress. Stress reactivity was defined as the difference in values between tasks and baseline, and post-stress recovery as the difference between recovery levels and baseline.
Resting blood pressure measured at baseline and 3 years later. Seven individuals had been prescribed hypertensive medication on follow-up.
Increases in systolic blood pressure (SBP) were predicted by impaired post-stress recovery of SBP (P < 0.001), diastolic blood pressure (DBP) (P < 0.001) and total peripheral resistance (P = 0.003), independently of baseline blood pressure, age, gender, socio-economic status, hypertensive medication, body mass and smoking. The adjusted odds of an increase in SBP > or = 5 mmHg were 3.50 [95% confidence interval (CI) 1.19 to 10.8] for individuals with poor compared with effective post-stress recovery of SBP. Three-year increases in diastolic pressure were predicted by impaired recovery of SBP (P < 0.001) and DBP (P = 0.009) pressure and by heart rate variability during tasks (P = 0.002), independently of covariates.
Impaired post-stress recovery and less consistently heightened acute stress reactivity may index disturbances in the regulation of cardiovascular stress responses that contribute to longitudinal changes in blood pressure in middle-aged men and women.
评估急性心理应激暴露后心血管恢复率的变化是否能独立于基线血压和其他协变量，纵向预测血压变化。
一项为期3年的纵向研究。
共209名基线年龄在45 - 59岁之间、无心血管疾病（包括高血压）病史的男性和女性。
在静息状态下、两项中度应激行为任务期间以及应激后长达45分钟，测量血压、心率、心率变异性、心脏指数和总外周阻力。应激反应性定义为任务与基线之间的值差，应激后恢复定义为恢复水平与基线之间的差值。
在基线和3年后测量静息血压。随访时有7人被开了降压药。
收缩压（SBP）的升高可由SBP（P < 0.001）、舒张压（DBP）（P < 0.001）和总外周阻力（P = 0.003）应激后恢复受损预测，独立于基线血压、年龄、性别、社会经济地位、降压药、体重和吸烟情况。与SBP应激后恢复有效相比，恢复不佳的个体SBP升高≥5 mmHg的校正比值比为3.50 [95%置信区间（CI）1.19至10.8]。舒张压的3年升高可由SBP（P < 0.001）和DBP（P = 0.009）恢复受损以及任务期间的心率变异性（P = 0.002）预测，独立于协变量。
应激后恢复受损以及急性应激反应性升高不太一致可能表明心血管应激反应调节存在紊乱，这会导致中年男性和女性血压的纵向变化。
