Abstract
Substantial evidence links exaggerated mental stress induced blood pressure reactivity to future hypertension, but the results for heart rate reactivity are less clear. For this reason multivariate cluster analysis was carried out to examine the relationship between heart rate and blood pressure reactivity patterns and hypertension in a large prospective cohort (age range 55–60 years). Four clusters emerged with statistically different systolic and diastolic blood pressure and heart rate reactivity patterns. Cluster 1 was characterised by a relatively exaggerated blood pressure and heart rate response while the blood pressure and heart rate responses of cluster 2 were relatively modest and in line with the sample mean. Cluster 3 was characterised by blunted cardiovascular stress reactivity across all variables and cluster 4, by an exaggerated blood pressure response and modest heart rate response. Membership to cluster 4 conferred an increased risk of hypertension at 5-year follow-up (hazard ratio=2.98 (95% CI: 1.50–5.90), P<0.01) that survived adjustment for a host of potential confounding variables. These results suggest that the cardiac reactivity plays a potentially important role in the link between blood pressure reactivity and hypertension and support the use of multivariate approaches to stress psychophysiology.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Matthews KA, Woodall KL, Allen MT . Cardiovascular reactivity to stress predicts future blood pressure status. Hypertension 1993; 22: 479–485.
Carroll D, Phillips AC, Der G, Hunt K, Benzeval M . Blood pressure reactions to acute mental stress and future blood pressure status: data from the 12-year follow-up of the West of Scotland study. Psychosom Med 2011; 73: 737–742.
Matthews KA, Katholi CR, McCreath H, Whooley MA, Williams DR, Zhu S et al. Blood pressure reactivity to psychological stress predicts hypertension in the CARDIA study. Circulation 2004; 110: 74–78.
Tuomisto M . Intra-arterial blood pressure and heart rate reactivity to behavioral stress in normotensive, borderline, and mild hypertensive men. Health Psychol 1997; 16: 554–565.
Chida Y, Steptoe A . Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta-analysis of prospective evidence. Hypertension 2010; 55: 1026–1032.
Hastrup JL, Light KC, Obrist PA . Parental hypertension and cardiovascular responses to stress in healthy young adults. Psychophysiology 1982; 19: 615–622.
von Eiff AW, Gogolin E, Jacobs U, Neus H . Heart rate reactivity under mental stress as a predictor of blood pressure development in children. J Hypertens 1985; 3: S89–S91.
Vrijkotte TGM, van Doornen LJP, de Geus EJC . Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension 2000; 35: 880–886.
Carroll D, Phillips AC, Der G . Body mass index, abdominal adiposity, obesity, and cardiovascular reactions to psychological stress in a large community sample. Psychosom Med 2008; 70: 653–660.
Ginty AT, Jones A, Carroll D, Roseboom TJ, Phillips AC, Painter R et al. Neuroendocrine and cardiovascular reactions to acute psychological stress are attenuated in smokers. Psychoneuroendocrinology 2014; 48: 87–97.
Panknin TL, Dickensheets SL, Nixon SJ, Lovallo WR . Attenuated heart rate responses to public speaking in individuals with alcohol dependence. Alcohol Clin Exp Res 2002; 26: 841–847.
Manuck SB . Cardiovascular reactivity in cardiovascular disease: “once more unto the breach”. Int J Behav Med 1994; 1: 4–31.
Klabunde RE . Cardiovascular Physiology Concepts. Lippincott Williams & Wilkins: New York, NY, 2005.
Roseboom TJ, van der Meulen JHP, Ravelli ACJ, Osmond C, Barker DJP, Bleker OP . Effects of prenatal exposure to the Dutch famine on adult disease in later life: an overview. Mol Cell Endocrinol 2001; 185: 93–98.
Roseboom TJ, Painter RC, van Abeelen AFM, Veenendaal MVE, de Rooij SR . Hungry in the womb: what are the consequences? Lessons from the Dutch famine. Maturitas 2011; 70: 141–145.
Veenendaal MVE, Painter RC, de Rooij SR, PMM Bossuyt, JAM van der Post, Gluckman PD et al. Transgenerational effects of prenatal exposure to the 1944-45 Dutch famine. BJOG 2013; 120: 548–554.
Bakker B, Seiben I . Maten voor prestige, social-economische status en sociale klasse voor de standard beroepenclassificatie. Soc Wetenschap 1992; 40: 1–22.
Zigmond AS, Snaith RP . The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–370.
de Rooij SR, Schene AH, Phillips DI, Roseboom TJ . Depression and anxiety: associations with biological and perceived stress reactivity to a psychological stress protocol in a middle-aged sample. Psychoneuroendocrinology 2010; 35: 866–877.
Ginty AT, Carroll D, Roseboom TJ, Phillips AC, de Rooij SR . Depression and anxiety are associated with a diagnosis of hypertension 5 years later in a cohort of late middle-aged men and women. J Hum Hypertens 2013; 27: 187–190.
Kamarck TW, Jennings JR, Manuck SB . Psychometric applications in the assessment of cardiovascular reactivity. Homeostasis Health Dis 1992; 34: 229–243.
Ward JH . Hierarchical grouping to optimise an objective function. J Am Stat Assoc 1963; 58: 236–244.
Jonas BS, Franks P, Ingram DD . Are symptoms of anxiety and depression risk factors for hypertension? Arch Fam Med 1997; 6: 643–649.
Itamar G, Michael H, Yehonatan S . Hypertension and socioeconomic status. Curr Opin Cardiol 2008; 23: 335–339.
Kannel WB . Risk factors in hypertension. J Cardiovasc Pharm 1989; 13: S4–S10.
Mooi E, Sarstedt M . Cluster analysis. In: Mooi E, Sarstedt M (eds). A Concise Guide to Market Research, 1st edn. Springer-Verlag: Berlin, Heidelberg, Germany, 2011, p 243.
Folkow B . “Structural factors” in primary and secondary hypertension. Hypertension 1990; 16: 89–101.
Lambiase MJ, Dorn J, Roemmich JN . Metabolic and cardiovascular adjustments during psychological stress and carotid artery intima-media thickness in youth. Physiol Behav 2012; 105: 1140–1147.
Roemmich J, Feda DM, Seelbinder AM, Lambiase MJ, Kala GK, Dorn J . Stress-induced cardiovascular reactivity and atherogenesis in adolescents. Atherosclerosis 2011; 215: 465–470.
Jennings JR, Kamarck TW, Everson-Rose SA, Kaplan GA, Manuck SB, Salonen JT . Exaggerated blood pressure responses during mental stress are prospectively related to enhanced carotid atherosclerosis in middle-aged Finnish men. Circulation 2004; 110: 2198–2203.
Lipman RD, Grossman P, Bridges SE, Hamner JW, Taylor JA . Mental stress responses, arterial stiffness, and baroreflex sensitivity in healthy aging. J Gerontol Biol Sci 2002; 57: B279–B284.
Uchino BN, Birmingham W, Berg CA . Are older adults less or more physiologically reactivity? A meta-analysis of age-related differences in cardiovascular reactivity to laboratory tasks. J Gerontol Psychol Sci 2010; 65B: 154–162.
Allen MT, Boquet AJ, Shelley KS . Cluster analysis and cardiovascular responsivity to three laboratory stressors. Psychosom Med 1991; 53: 272–288.
Mills PJ, Dimsdale JE, Nelesen RA, Jasiewicz J, Ziegler MG, Kennedy B . Patterns of adrenergic receptors and adrenergic agonists underlying cardiovascular responses to a psychological challenge. Psychosom Med 1994; 56: 70–76.
Clatworthy J, Buick D, Hankins M, Weinman J, Horne R . The use and reporting of cluster analysis in health psychology. Br J Health Psychol 2005; 10: 329–358.
Acknowledgements
We thank the participants for their willing cooperation. Data collection was supported by the Netherlands Heart Foundation (grant numbers 2001B087 and 2003B165). SdR was supported by European Community FP7 HEALTH Project 279281 (BRAINAGE). These funding sources had no role in study design, data collection, analysis and interpretation of the data. AG is funded by T32 HL07560.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Brindle, R., Ginty, A., Jones, A. et al. Cardiovascular reactivity patterns and pathways to hypertension: a multivariate cluster analysis. J Hum Hypertens 30, 755–760 (2016). https://doi.org/10.1038/jhh.2016.35
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jhh.2016.35