Markovitz J H, Raczynski J M, Wallace D, Chettur V, Chesney M A
Division of Preventive Medicine, University of Alabama at Birmingham 35205, USA.
Psychosom Med. 1998 Mar-Apr;60(2):186-91. doi: 10.1097/00006842-199803000-00014.
This study was undertaken to determine the relationship between heightened reactivity of blood pressure (BP) during stress and 5-year changes in blood pressure and hypertensive status, using the CARDIA study.
A total of 3364 participants (910 white men, 909 white women, 678 black men, and 867 black women), initially 20 to 32 years old and normotensive, were included. Cardiovascular reactivity to psychological stressors (video game and star-tracing tasks for 3 minutes, cold pressor test for 1 minute) was measured in 1987-1988. We then examined reactivity as a predictor of significant BP change (> or = 8 mm Hg, thought to represent a clinically significant increase) over the next 5 years. Logistic regression models were used to control for potential covariates. Significant BP change and the development of hypertension (BP greater than 140/90 or taking medication for hypertension) over the 5-year follow-up were examined in separate analyses.
Increased systolic blood pressure (SBP) reactivity to the video game was associated with a significant 5-year SBP increase among the entire cohort, independent of resting SBP (p < .0001). Subsequent analyses showed that this relationship held for men but not for women. Reactivity to the star-tracing task or the cold pressor test did not predict significant BP change. Among black men only, new hypertensives (N = 36) had greater diastolic blood pressure (DBP) reactivity to the video game (p = .01).
Although BP reactivity to all physical and mental stressors used in this study did not consistently predict 5-year change in BP in this young cohort, the results indicate that reactivity to a video game stressor predicts 5-year change in BP and early hypertension among young adult men. These findings are consistent with other studies showing the usefulness of stressors producing a primarily beta-adrenergic response in predicting BP change and hypertension. The results may be limited by the shortened initial rest and recovery periods used in the CARDIA protocol.
本研究利用CARDIA研究来确定应激期间血压（BP）反应性增强与5年血压变化及高血压状态之间的关系。
共有3364名参与者（910名白人男性、909名白人女性、678名黑人男性和867名黑人女性）被纳入研究，他们最初年龄在20至32岁之间，血压正常。在1987 - 1988年测量了心血管对心理应激源（3分钟的电子游戏和描星任务、1分钟的冷加压试验）的反应性。然后我们将反应性作为接下来5年中显著血压变化（≥8 mmHg，被认为代表临床上显著升高）的预测指标进行研究。使用逻辑回归模型来控制潜在的协变量。在单独的分析中检查了5年随访期间的显著血压变化和高血压的发生（血压大于140/90或正在服用抗高血压药物）。
在整个队列中，电子游戏引起的收缩压（SBP）反应性增加与5年SBP显著升高相关，独立于静息SBP（p <.0001）。后续分析表明这种关系在男性中成立，但在女性中不成立。对描星任务或冷加压试验的反应性不能预测显著的血压变化。仅在黑人男性中，新患高血压者（N = 36）对电子游戏的舒张压（DBP）反应性更高（p =.01）。
尽管本研究中使用的所有身心应激源引起的血压反应性并不能始终预测该年轻队列中5年的血压变化，但结果表明对电子游戏应激源的反应性可预测年轻成年男性5年的血压变化和早期高血压。这些发现与其他研究一致，这些研究表明主要产生β - 肾上腺素能反应的应激源在预测血压变化和高血压方面是有用的。结果可能受到CARDIA方案中缩短的初始休息和恢复期的限制。
