title: Measures of total stress-induced blood pressure responses are associated with vascular damage.
abstract: BACKGROUND
  The role of cardiovascular reactivity to study hypertension, and the assessment methods, are still controversial. We aimed to verify the association of hypertension and vascular damage with several measures of cardiovascular response.
  
  
  METHODS
  We studied 40 patients with normal-high (132 +/- 1/87 +/- 1 mm Hg) blood pressure (Group 1) and 80 untreated hypertensive subjects. Postischemic forearm vascular resistance (mFVR) served to differentiate hypertensive subjects (142 +/- 2/92 +/- 1 mm Hg v 143 +/- 2/94 +/- 2 mm Hg, P = NS) with a lower (Group 2) and higher (Group 3) hemodynamic index of vascular damage (4.8 +/- .05 v 6.3 +/- .09, P < .001). Reactivity was induced by Stroop (5') and cold pressor (90") tests. We measured muscular contraction and skin conductance as indices of emotional arousal, blood pressure, heart rate, forearm blood flow, and vascular resistance. Reactivity measures included: a) change from baseline, b) residualized score, c) cumulative change from baseline and residualized score, and d) total reactivity as area-under-the-curve (AUC), including changes occurring during baseline and recovery phases.
  
  
  RESULTS
  The AUC of systolic blood pressure, diastolic blood pressure, and mFVR progressively increased in the groups (P < .001). Corrections of anthropometric and metabolic confounders were introduced in the Pearson equation between mFVR and reactivity measures. The AUC of SBP, DBP, and forearm blood flow and resistance demonstrated the highest (P < .001) correlation. On multiple regression analysis, AUC of SBP (beta = 0.634) and forearm blood flow (beta = -0.337) were predictive (P < .001) of vascular damage.
  
  
  CONCLUSIONS
  Total blood pressure stress response, as AUC, including baseline and recovery phases, was significantly better associated with hypertension and vascular damage than the other reactivity measures studied.
authors.affiliation: Department of Clinical Methodology and Medico-Surgical Technology, Section of Internal Medicine and Hypertension, University of Bari, Policlinico Consorziale, Piazza Giulio Cesare 11, 70124 Bari, Italy. nazzaro@htn.uniba.it
authors.forename: Pietro
authors.initials: P
authors.lastname: Nazzaro
authors.forename: Teresa
authors.initials: T
authors.lastname: Seccia
authors.forename: Vito
authors.initials: V
authors.lastname: Vulpis
authors.forename: Gabriella
authors.initials: G
authors.lastname: Schirosi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Serio
authors.forename: Loredana
authors.initials: L
authors.lastname: Battista
authors.forename: Anna
authors.initials: A
authors.lastname: Pirrelli
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D003080:Cold Temperature; D005260:Female; D005542:Forearm / Q000098:blood supply; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007511:Ischemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013312:Stress, Physiological / Q000503:physiopathology*; D013315:Stress, Psychological / Q000503:physiopathology; D014655:Vascular Resistance