Renal function and cardiovascular response to mental stress.
OBJECTIVE
Cardiovascular reactivity (CVR), defined as an exaggerated hemodynamic response to mental stress, is a putative vascular risk factor and may reflect sympathetic hyperactivity. Chronic kidney disease (CKD) is also associated with sympathetic hyperactivity and vascular risk, but its relationship with CVR is unknown.


METHODS
CVR was assessed in 107 individuals without overt cardiovascular disease or diabetes. Blood pressure and heart rate responses were elicited by three experimental tasks designed to evoke mental stress. Glomerular filtration rate (eGFR) was estimated using the MDRD formula. General linear models estimated the association between renal function and CVR, adjusting for potential confounders.


RESULTS
Mean age was 66 years and 11% had eGFR of <60 ml/min/1.73 m2. After multivariate adjustment, a low eGFR was associated with a greater stress response of systolic blood pressure, heart rate, and pulse pressure. Associations were only partially attenuated after adjustment for lipids and glucose tolerance. When considered as a continuous variable, lower eGFR was associated with a greater blood pressure response after adjustment for glycemia.


CONCLUSIONS
Although there were relatively few participants with CKD, these results suggest a relationship between CKD and greater CVR. Further investigation is warranted into factors that mediate this relationship and potential clinical consequences of this exaggerated response to stress in CKD.
Seliger
Stephen L
SL
University of Maryland School of Medicine, Maryland VA Healthcare System, Baltimore County, Baltimore, MD 21201, USA. sseliger@medicine.umaryland.edu
Katzel
Leslie I
LI
Fink
Jeffrey C
JC
Weir
Matthew R
MR
Waldstein
Shari R
SR
D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology; D002319:Cardiovascular System / Q000473:pathology*; D005260:Female; D005919:Glomerular Filtration Rate; D005947:Glucose / Q000378:metabolism; D006339:Heart Rate; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008055:Lipids / Q000737:chemistry; D008297:Male; D013315:Stress, Psychological; D016896:Treatment Outcome
D008055:Lipids; D005947:Glucose