title: Blood Pressure Reactivity to Psychological Stress in Young Adults and Cognition in Midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.
abstract: BACKGROUND
  The classic view of blood pressure (BP) reactivity to psychological stress in relation to cardiovascular risks assumes that excess reactivity is worse and lower reactivity is better. Evidence addressing how stress-induced BP reactivity in young adults is associated with midlife cognitive function is sparse.
  
  
  RESULTS
  We assessed BP reactivity during a star tracing task and a video game in adults aged 20 to 32 years. Twenty-three years later, cognitive function was assessed with use of the Digit Symbol Substitution Test (a psychomotor speed test), the Rey Auditory Verbal Learning Test (a verbal memory test), and the modified Stroop test (an executive function test). At the time of follow-up, participants (n=3021) had a mean age of 50.2 years; 56% were women, and 44% were black. In linear regression models adjusted for demographic and clinical characteristics including baseline and follow-up resting BP, lower systolic BP (SBP) reactivity during the star tracing and video game was associated with worse Digit Symbol Substitution Test scores (β [SE]: 0.11 [0.02] and 0.05 [0.02], respectively) and worse performance on the Stroop test (β [SE]: -0.06 [0.02] and -0.05 [0.02]; all P<0.01). SBP reactivity was more consistently associated than diastolic BP reactivity with cognitive function scores. The associations between SBP reactivity and cognitive function were mostly similar between blacks and whites.
  
  
  CONCLUSIONS
  Lower psychological stress-induced SBP reactivity in younger adults was associated with lower cognitive function in midlife. BP reactivity to psychological stressors may have different associations with target organs in hypertension.
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., P.G., D.L.J., K.L.).
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., P.G., D.L.J., K.L.).
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.).
authors.forename: Jared P
authors.initials: JP
authors.lastname: Reis
authors.affiliation: Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, AL (C.E.L.).
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.).
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA (N.B.).
authors.forename: R Nick
authors.initials: RN
authors.lastname: Bryan
authors.affiliation: Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, San Francisco, CA (K.Y.).
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA (S.S.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.affiliation: University of Geneva, Switzerland (E.A.).
authors.forename: Emiliano
authors.initials: E
authors.lastname: Albanese
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., P.G., D.L.J., K.L.).
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., P.G., D.L.J., K.L.).
authors.forename: Donald
authors.initials: D
authors.lastname: Lloyd-Jones
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., H.N., P.G., D.L.J., K.L.).
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000375:Aging / Q000208:ethnology / Q000523:psychology*; D001794:Blood Pressure; D003071:Cognition; D003072:Cognition Disorders / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D003324:Coronary Artery Disease / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D056344:Executive Function; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008568:Memory; D008875:Middle Aged; D015999:Multivariate Analysis; D011597:Psychomotor Performance; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology; D057190:Stroop Test; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D018910:Video Games; D044465:White People; D055815:Young Adult
keywords: blood pressure; blood pressure monitoring; cognition; stress test; young