Published Online
on September 27, 2004

A more recent version of this article appeared on October 12, 2004

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Submitted on March 8, 2004
Revised on April 8, 2004
Accepted on May 18, 2004

Exaggerated Blood Pressure Responses During Mental Stress Are Prospectively Related to Enhanced Carotid Atherosclerosis in Middle-Aged Finnish Men

J. Richard Jennings PhD^*, Thomas W. Kamarck PhD, Susan A. Everson-Rose PhD, George A. Kaplan PhD, Stephen B. Manuck PhD, and J. T. Salonen MD

From the Departments of Psychiatry and Psychology, University of Pittsburgh, Pa (J.R.J., T.W.K., S.B.M.); the Department of Preventive Medicine and Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Ill (S.A.E.-R.); the Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor (G.A.K.); and the Research Institute of Public Health and Department of Community Health and General Practice, University of Kuopio, Finland, and Jurilab, Ltd, Kuopio (J.T.S.).

^* To whom correspondence should be addressed. E-mail: JenningsJR{at}upmc.edu.

Background--Hemodynamic reactions to mental stress may contribute to atherosclerosis. We previously observed cross-sectional relationships between blood pressure reactions to a standardized stress battery and carotid intima-media thickness (IMT) in the Kuopio Ischemic Heart Disease (KIHD) study. These are the first prospective results on this relationship.

Methods and Results--Men from 4 age cohorts (42 to 60 years old at study onset) were challenged with a standardized mental stress battery, and heart rate and blood pressure reactions were assessed. Ultrasound measures of common carotid IMT were collected at this time and 7 years later as noninvasive markers of atherosclerosis. Data were collected from a sample of 756 men at both times. Systolic blood pressure reactions to mental stress at study onset were positively related to mean carotid IMT 7 years later (=0.035, P=0.001, by blood pressure quartile, IMT=0.91, 0.93, 0.96, 1.00 mm) and to the progression of IMT (=0.020, P=0.006, by blood pressure quartile, IMT=0.08, 0.09, 0.11, 0.11 mm). Similar significant relations were shown for maximal IMT and plaque height. Diastolic blood pressure responses were less strongly related to carotid IMT than were systolic responses. Heart-rate responses were unrelated. Adjustment for standard risk factors did not substantially reduce the relation between systolic blood pressure reactivity and the progression of mean carotid IMT (standardized =0.059, P=0.026), maximal carotid IMT (standardized =0.084, P=0.006), or plaque height (standardized =0.093, P=0.008).

Conclusions--The degree of systolic blood pressure reactivity to mental challenge is prospectively related to carotid IMT in middle-aged and older men, independent of known risk factors.

Key words: atherosclerosis • cardiovascular diseases • carotid arteries • risk factors • stress

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