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Stress Induced Blood Pressure Reactivity Associated with Silent Cerebrovascular Disease

Greater stress-induced blood pressure (BP) reactivity appears to be associated with enhanced silent cerebrovascular disease as measured by magnetic resonance imagining (MRI) in healthy asymptomatic older adults, and is independent of resting BP levels, new research suggests.

Silent brain infarction has been detected in about one fourth of elderly participants in clinical trials. In addition, evidence of white matter disease has been found in 83% of stroke-free participants older than 64 years.

Exaggerated BP responses to mental stress provide an index of autonomic dysregulation. Therefore, Shari R. Waldstein, PhD, with the Department of Psychology at the University of Maryland, Baltimore, United States and colleagues examined the association of stress-induced BP reactivity with silent cerebrovascular disease assessed by MRI in healthy older adults.

"This study was, to our knowledge, the first to examine the relation of stress-induced BP reactivity to indices of silent cerebrovascular disease assessed by MRI," the researchers note.

A total of 67 healthy community-dwelling adults (ages 55 to 81; 75% male) participated in the study. Resting systolic and diastolic BP measurements were assessed as were BP responses to 3 laboratory-based mental stressors. The 3-minute stressors involved anger recall, speech/role play, and mental arithmetic, and were chosen to evoke negative emotions.

In addition, MRIs were rated for small silent infarcts (lesions of 3 mm or more), infarct-like lesions (less than 3 mm), and periventricular and deep white matter hyperintensities (WMH).

After adjusting for age, gender, resting BP, and fasting glucose levels, the researchers found that higher systolic BP reactivity was associated with an increased number of small silent infarcts (P = .004) and greater severity ratings of periventricular (P < .04) and deep WMH (P < .05).

Likewise, higher diastolic BP reactivity was associated with an increased number of small silent infarcts (P < .04), and greater severity ratings of periventricular (P < .04) and deep WMH (P = .009).

"Exaggerated systolic and diastolic BP responses to mental stressors were associated with a greater number of silent brain infarctions and relatively higher severity ratings of WMH, explaining between 6% and 14% of the variance in these measures," Dr. Waldstein and colleagues conclude.

According to the researchers. exaggerated stress-induced BP reactivity warrants further examination as a potential biobehavioural risk factor for cerebrovascular disease.


Stroke 2004;35:1294-1298. Epub 2004 Apr 15. "Stress-induced blood pressure reactivity and silent cerebrovascular disease"

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