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UDC 616.12-008.331.1-036
STRESS REACTIVITY: CLINICAL ASPECTS
Altai State Medical University, Barnaul I.V. Osipova, O.N. Antropova
Increased stress reactivity of arterial pressure (AP) is probably one of the central pathogenic theories and also one of the most important precursory clinical symptoms of cardiovascular diseases. According to the recent researches, the implementation of various types of stress tests in healthy people and patients with AH allows to gain important additional information not only on the functional state and spare capacities of the cardio-vascular system, but also to evaluate prognosis and risk of disease development in a number of cases. The article presents the overview of literature data and lasting observations devoted to the relation of increased stress reactivity with risk factors, state of vessel wall, cardiovascular prognosis. The revealed peculiarities create a more broad picture of pathogenetic influence of stress reactivity and in prospect allow to create individual prognosis of CV event with further elaboration of effective preventive programs.
Key words: stress reactivity, vessels, sympathoadrenal system, arterial hypertension.
Increased stress reactivity of arterial pressure (AP) is probably one of the central pathogenic theories and also one of the most important precursory clinical symptoms of such common disease as arterial hypertension (AH) [1]. The pathophysiological mechanism explaining the fluctuations of AP in response to psychological tests is, first and foremost, hyperreactivity of sympathetic nervous system (SNS), which is directly connected with cardio-vascular incidence and mortality. The implementation of various types of stress tests in healthy people and patients with AH allows to gain important additional information not only on the functional state and spare capacities of the cardio-vascular system, but also to evaluate prognosis and risk of disease development in a number of cases.
It is proved, that the emotional stress can not only increase AP, but also intensify its fluctuations [2]. Thus, pressor response to AP measurement by sphygmomanometer was connected with complex changes of SNS activity, conditioned by central regulation from diencephalic zone responsible for emotions and behavioral reactions [3].
There is contradictory information on the possibility of performance of psycho-mental stress tests in practice, and search of the most available laboratory test is still ongoing [4,5]. The implementation of various types of stress tests in healthy people and patients with AH allows to gain important additional information not only on the functional state and spare capacities of the cardiovascular system, but also to evaluate prognosis and risk of disease development in a number of cases.
"Mathematic count" test and test with public reading of an unknown text are most widely used as tests imitating critical psychoemotional pressure. "Mathematic count" consisted in mental subtraction of one-figure number (7) from three-figure number (624) with attention switch in conditions of time shortage, disturbance and criticism of the work of examined person during next 3 minutes. AP and CR (cardiac rate) are registered initially, in the end
of the 1st, 2nd and 3rd minutes of count. Then there was calculated the gain rate of AP and CR, comparing the initial data with maximum values in absolute terms and percent. Increased stress reactivity is characterized by SAP (stress reactivity of arterial pressure) growth by more then 7%, and/ or CR growth by more than 10%. Test sensitivity -100%, specificity - 75%, effectiveness - 87% [6].
Relation of hemodynamics of stress reactivity with behavioral and psychosocial risk factors
The conducted research revealed a number of relations between hemodynamics parameters by the test "MC" and risk factors of CVM (cardiovascular morbidity) in men with arterial hypertension [7]. In patients with early cardiovascular medical history, compared to persons without family history, there is a considerable growth of SAP by 35,0% (p = 0,001).
There were determined direct correlation dependences of the growth of SAP (r = 0,4; p = 0,01) and DAP (diastolic arterial pressure) (r = 0,4; p = 0,009) with aging. Patients with abdominal obesity had bigger increase of SAP and CR by 33,8% (p = 0,001) and 25,4% respectively then the patients with normal waist circumference. The literature contains opposite data on the influence of obesity on patient stress reactivity. In the work of A. Garafova and co-authors 2014 it was shown, that the presence of obesity does not change the reaction of AP and catecholamines on psychological mental test in young persons with AH [8]. Other researches, as well as ours, revealed high reaction ability in response to stress in patients with obesity [9]. Probably the obtained contradictory conclusions are connected with the differences in basal layers of SNS and with different reactions of AP and catecholamines by various types of stress tests.
We had revealed associations of stress reactivity with psychosocial and behavioral risk factors. It was found, that the men smoked with the same frequency irrespective of the stress reactivity of hemodynamics (40,6% and 31,2% respectively).
However, men with increased stress reactivity smoked 30 cigarettes per day, while men with normal stress reactivity smoked 20 cigarettes per working day. Persons with positive stress reactivity misused alcohol by 12,9% (p>0,05) more frequently than the persons with normal stress reactivity. Among the men with increased stress reactivity of hemodynamics subclinical anxiety according to HADS-T scale was met 3,9 times oftener (x2 = 7,71; p = 0,005) than in persons with normal stress reactivity of hemodynamics. The occurrence of subclinical depression according to HADS-T scale in the examined persons stayed on the same level (6,3 and 4,8% respectively) [10].
Stress reactivity: is there an influence on the
vessels?
The previously conducted researches showed, that irrespective of the implied test stress reactivity and low post-stress recovery are associated with the increase of AP, growth of LV (left ventricle) mass, subclinical atherosclerosis [11]. The research of Korean authors (Logan J. G., 2012) showed, that anxiety and emotional reaction to stress considerably preconditioned arterial stiffness in persons under 60. The authors of the research suppose, that arterial stiffness can be a mechanism explaining the correlation between anxiety and risk of arterial hypertension [12].
According to our research [13], the relation of reactivity of hemodynamics in response to stress depends on the initial state of patients. It was revealed, that persons with pre-hypertension state (high normal arterial pressure) having increased stress reactivity in the test "mathematical count" are characterized by higher frequency of IMT growth (intimomedial thickness) 0.9-1,3mm of brachiocephalic vessels (BCV) by 1,9 times (x2=5,12, p=0,02) and of atheromas (IMT.1,3mm) by 3,7 times (x2=6,3, p=0,01) in comparison with the examined persons with normal reactivity. By arterial hypertension IMT of BCV did not depend on the type of reaction. However, it was stated, that patients with increased stress reactivity compared to normal reactivity have higher frequency of vascular stiffness (pulse wave velocity >10 m/s) by 6,1 times (x2=22,56, p<0,001) by pre-hypertension and by 2,8 times (x2=15,9, p=0,001) by AH. Moreover, in men with increased stress reactivity the increase of central aortal pressure (indicator of arterial stiffness) is registered more frequently by 2,1 times (x2=9,56, p<0,001) by pre-hypertension and by 2,8 times (x2=15,9, p=0,001) by AH.
From a practical perspective, interesting are the results showing that by increased stress reactivity men with pre-hypertension have a comparable frequency of asymptomatic vascular disorder with the same by AH. It should be noted, that stratification of cardiovascular risk in persons with
preOhypertension, as well as in young patients with 1st degree of AH, is not thoroughly determined. In our opinion, the implementation of stress test "mathematical count" allows to reveal the group of patients, who need additional methods of research for the evaluation of the state of vessel wall and determination of modern preventive tactics. It is important, that this method is screening, does not require additional equipment and is not time-consuming.
Stress reactivity and cardiovascular prognosis
It is known, that the influence of stress factor launches a series of cascade reactions leading to various hemodynamic changes with the formation of increased stress reactivity and risk of the development of CVD (cardiovascular disease) and CVC (cardiovascular complications) [15,16]. However, there are opposite results and there is still no consensus. The probable reason of that can be gender differences of stress reactivity and the influence of other factors.
We had made a retrospective study (n = 204) devoted to the determination of predictors of SSS in men with AH [17]. The results were evaluated 5 years and 1 year before CVC onset. The logit regressive analysis revealed, that the most significant factors 5 years before CVC were: LDL cholesterol.3,0 mmol/l, CR>80 bpm, DAP >90 mmhg, TG>1,7 mmol/l, early family history of CCD, TC >5,0 mmol/l, age and smoking. The reactivity of hemodynamics contributed to CVC by increase of DAP by the test "Mathematical count" >6% (OR=2,87, 95% CI 1,12-7,38, p=0,03), increase of CR>10% (OR=2,9, 95% CI 1,03-8,15, p=0,04). 1 year before CVC development the presence of increase by "MC" test of SAP>7% and CR>10% increased the risk of CVC development by 3 times (p=0,04 and p=0,02 respectively), and DAP>6% - by 9 times (p=0,006).
The revealed peculiarities create a more broad picture of pathogenetic influence of stress reactivity and in prospect allow to create individual prognosis of CV event with further elaboration of effective preventive programs.
References
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Contacts:
656038, Barnaul, Lenina Prospect, 40.
Altai State Medical University.
Tel.: (3852) 201279.
Email: i.v.osipova@gmail.com
