title: Cardiovascular reactivity and development of preclinical and clinical disease states.
abstract: OBJECTIVE
  The objective of this review is to evaluate the evidence for the hypothesis that cardiovascular reactivity can predict the development of preclinical (elevated blood pressure, ventricular remodeling, carotid atherosclerosis) and/or clinical cardiovascular disease states.
  
  
  METHODS
  A review of the literature was conducted examining prospective studies.
  
  
  RESULTS
  Three large epidemiological studies with long-term follow-up periods (20 years or more) have found blood pressure responses to the cold pressor task to be predictive of subsequent essential hypertension in initially normotensive samples. Studies showing less consistent results have tended to use shorter-term follow-up periods. A larger body of literature demonstrates consistent associations between stress-related cardiovascular reactivity and blood pressure elevations in youth over the course of 1 to 6 years; such relationships have not been consistently shown among adult samples. Moderately consistent evidence points to a positive relationship between reactivity and other measures of subclinical disease (increased left ventricular mass and carotid atherosclerosis) among the few prospective studies that have examined these issues to date. A number of additional factors, however, such as baseline levels of disease risk and exposure to psychosocial stress, seem to moderate these relationships. Health status at baseline also seems to moderate the association between reactivity and clinical coronary heart disease in recent reports: two of three existing studies in initially healthy samples show no evidence of a relationship between reactivity and clinical outcomes, whereas three of four studies in samples with preexisting coronary heart disease or essential hypertension show a positive relationship between reactivity and subsequent disease states.
  
  
  CONCLUSIONS
  There is reasonable evidence to suggest that cardiovascular reactivity can predict the development of some preclinical states (eg, increased left ventricular mass and blood pressure) states and perhaps even new clinical events in some patients with essential hypertension or coronary heart disease. However, much more information is needed concerning moderating and potentially confounding variables before the robustness of the positive relationships can become clinically useful.
authors.affiliation: Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, Georgia 30912, USA. ftreiber@mail.mcg.edu
authors.forename: Frank A
authors.initials: FA
authors.lastname: Treiber
authors.forename: Thomas
authors.initials: T
authors.lastname: Kamarck
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
authors.forename: David
authors.initials: D
authors.lastname: Sheffield
authors.forename: Gaston
authors.initials: G
authors.lastname: Kapuku
authors.forename: Teletia
authors.initials: T
authors.lastname: Taylor
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D002319:Cardiovascular System / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003080:Cold Temperature; D015986:Confounding Factors, Epidemiologic; D004198:Disease Susceptibility; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012107:Research Design; D014463:Ultrasonography