Change in urinary cortisol excretion mediates the effect of angry/hostile mood on 9 month diastolic blood pressure in HIV+ adults.
Cardiovascular disease is a growing concern in HIV disease management and nearly 1 out of 3 persons living with the virus is hypertensive. Biobehavioral factors such as anger, hostility, and HPA axis reactivity are emperically linked to blood pressure regulation. Whether HPA axis or mood disturbance increases risk for hypertension remains unclear in HIV disease. The aim of this study was to determine whether 9-month change in angry/hostile mood predicts alterations in systolic (SBP) or diastolic blood pressure (DBP), and whether this change is mediated by 24-h urinary cortisol (CORT) output. Sixty-one HIV positive adults, aged 41.1 ± 8.6 years, assigned to the control condition of a stress management intervention provided blood samples, 24-h urine specimens, blood pressure in-office, and self-reported mood at baseline and a 9-month follow-up. CORT was tested as a mediator in two separate models controlling for baseline BP, CD4 count, HIV-1 viral load, protease inhibitor use, body mass index, smoking status, and family history of cardiometabolic disease. Increase in angry/hostile mood was associated with greater SBP (β = 0.33, CI 0.09, 0.56, p = 0.01) and DBP (β = 0.39, CI 0.16, 0.62, p < 0.001) at follow-up. CORT partially mediated the effect of angry/hostile mood on DBP (β = 0.28, CI 0.03, 0.54, p = 0.03). Change in CORT was not related to SBP (β = 0.12, CI -0.20, 0.44, p = 0.46). The final mediation model accounted for 41.2% of the variance in 9-month DBP. Angry or hostile mood may contribute to increased risk for hypertension in persons treated for HIV via disturbance of the HPA-axis.
Department of Psychology, University of Miami, Coral Gables, FL, USA. r.mcintosh@miami.edu.
Roger C
RC
McIntosh
Department of Psychology, University of Miami, Coral Gables, FL, USA.|Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.|Behavioral Medicine Research Center, Miller School of Medicine, University of Miami, Miami, FL, USA.|Division of Endocrinology, Diabetes and Metabolism, School of Medicine, University of Miami, Miami, FL, USA.
Michael
M
Antoni
Department of Community Health Systems, University of California, San Francisco, CA, USA.
Adam
A
Carrico
Alliant International University, Alhambra, CA, USA.
Ron
R
Duran
Department of Psychology, University of Miami, Coral Gables, FL, USA.|Behavioral Medicine Research Center, Miller School of Medicine, University of Miami, Miami, FL, USA.|Division of Endocrinology, Diabetes and Metabolism, School of Medicine, University of Miami, Miami, FL, USA.|Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA.
Barry E
BE
Hurwitz
Department of Psychology, University of Miami, Coral Gables, FL, USA.
Gail
G
Ironson
Miami Veterans Affairs Medical Center, Miami, FL, USA.|Institute for Neuro-immune Medicine, Nova Southeastern University, Davie, FL, USA.
Mary Ann
MA
Fletcher
Miami Veterans Affairs Medical Center, Miami, FL, USA.|Institute for Neuro-immune Medicine, Nova Southeastern University, Davie, FL, USA.
Nancy
N
Klimas
Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Mahendra
M
Kumar
Department of Psychology, University of Miami, Coral Gables, FL, USA.|Behavioral Medicine Research Center, Miller School of Medicine, University of Miami, Miami, FL, USA.|Miami Veterans Affairs Medical Center, Miami, FL, USA.
Neil
N
Schneiderman
D000328:Adult; D000339:Affect / Q000502:physiology; D000786:Anger / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000652:urine*; D006791:Hostility; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000652:urine*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology
D006854:Hydrocortisone
Anger; Anti-retroviral therapy; Blood pressure; Cortisol; Hostility; Human Immunodeficiency Virus; Mood