Temporal and inter-task consistency of heart rate reactivity during active psychological challenge: a twin study

Excess heart rate and systolic blood pressure during psychological stress in relation to metabolic demand in adolescents

Cardiovascular responses during exercise are matched to the increased metabolic demand, but this may not be the case during psychological stress. No studies to date have tested this hypothesis in youth. Fifty-four youth, ages 13-16 years completed two visits. Heart rate (HR), systolic blood pressure (SBP), and oxygen (O(2)) consumption were measured during a graded exercise test on one day and during psychological stress reactivity (star tracing, speech) on another day. Predicted HR and SBP values during psychological stress were calculated based on HR-O(2) and SBP-O(2) relationships calculated during graded exercise. At a given O(2) consumption, actual HR was greater (p<0.02) than predicted for all stress tasks. Actual SBP was greater (p<0.001) than predicted for all stress tasks. This was the first study to demonstrate that cardiovascular responses were in excess of what would be expected based on metabolic demand in youth.

Genetic influences on cardiovascular stress reactivity

Individual differences in the cardiovascular response to stress play a central role in the reactivity hypothesis linking frequent exposure to psychosocial stress to adverse outcomes in cardiovascular health. To assess the importance of genetic factors, a meta-analysis was performed on all published twin studies that assessed heart rate (HR) or blood pressure (BP) reactivity to the cold pressor test or various mental stress tasks. For reactivity to mental stress, the pooled heritability estimate ranged from 0.26 to 0.43. Reactivity to the cold pressor test yielded heritability estimates from 0.21 to 0.55. An ensuing review of genetic association studies revealed a number of genes, mostly within the sympathoadrenal pathway, that may account for part of the heritability of cardiovascular stress reactivity. Future progress in gene finding, that should include measures of sympathetic and vagal stress reactivity, may help uncover the molecular pathways from genetic variation to stress reactivity.

Blood pressure and pulse responses to three stressors: associations with sociodemographic characteristics and cardiovascular risk factors

Cardiovascular reactivity is hypothesized to increase the risk of hypertension and other CVD-related conditions. However, studies to date are inconclusive. We compared the association of blood pressure and pulse responses to three stressors (postural challenge, handgrip test, mental arithmetic) with sociodemographic characteristics and CVD risk factors. We included 782 participants from the Hypertension Genetic Epidemiology Study. Blood pressure and pulse responses to stressors were defined as the difference between post- and pre-stress measurements. Stepwise regression analyses examined change in SBP and pulse in response to stressors as a function of sociodemographic and CVD risk factors. Age, race, and gender were forced into models and other variables (education, BMI, waist circumference, resting SBP and DBP, cigarette smoking, LDL and HDL cholesterol, glucose, and antihypertensive medications (beta-blockers, calcium channel blockers, diuretics, ace inhibitors)) were retained if P<0.10. Age was a significant predictor of SBP response to all stressors. The SBP response to a change in posture was not related to other variables. The SBP response to mental arithmetic was significantly higher among men, those with larger waists, higher SBP, beta-blocker users, and lower among smokers. SBP response to the handgrip was significantly higher among those with higher SBP and beta-blocker users. Similarly, the association of the pulse response to the risk factors varied considerably across the stressors. Overall, the socio-demographic and CVD risk factors accounted for between 9 and 14% of the variance in the SBP response to the stressors and from between 4 and 12% of the variance in the pulse response to the three stressors. The associations between sociodemographic and CVD risk factors and the SBP and pulse response to stress were modest and inconsistent across stressors. The findings suggest that cardiovascular reactivity is a concept that needs to be defined in reference to specific stressors so that mechanisms leading to responses can be better understood.

Familiality of heart rate and cardiac-related autonomic activity in five-month-old twins: The Québec newborn twins study

The familiality of infant sleeping heart rate (HR) and cardiac-related autonomic activity, as indexed by spectral analysis of HR variability (HRV) and response to postural change, was investigated in 322 5-month-old twin pairs. The postural change elicited only minor changes in cardiovascular activity. As a result, analyses focused on supine cardiovascular activity. Multivariate genetic modeling indicated that individual differences in sleeping HR and high frequency (HF) HRV were determined by unique environmental and distinct additive genetic factors. These variables, along with low frequency (LF) HRV, were also affected by overlapping familial environmental influences. Familial influences in HF HRV were more pronounced for baby girls than boys. Estimates of relative LF and HF HRV were determined by common (familial) and unique environmental factors; familial influences on these estimates did not overlap with familial influences on sleeping HR.

Allelic variation in the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and cardiovascular reactivity in young adult male and female twins of European-American descent

OBJECTIVE

To examine the effect of length variation in the serotonin transporter gene-linked polymorphic region (5-HTTLPR) on individual differences in cardiovascular response to psychological challenge.

METHODS

Heart rate (HR) and systolic and diastolic blood pressure (SBP, DBP) responses to computerized versions of two psychological challenges, the Stroop Color-Word Interference Test and mental arithmetic, were measured among 131 monozygotic (MZ) and 60 dizygotic (DZ) male or female (same-sex) European-American twin pairs. Among the 382 participants, 140 were homozygous for the "long" allele (l/l) at 5-HTTLPR, 61 were homozygous for the "short" allele (s/s), and 181 participants had one long and one short allele (l/s). Association and sib-pair analyses were performed to characterize genetic associations.

RESULTS

In the full sample, 5-HTTLPR was associated with HR reactivity to psychological challenge, albeit in interaction with sex. Task-elicited HR responses of women homozygous for the short allele were significantly greater than among: a) men of the same genotype; and b) women having either one (l/s) or two (l/l) long alleles at 5-HTTLPR. SBP and DBP responsivity was unrelated to genotype. These results were corroborated on reanalysis in two genetically independent subsamples. Variability at 5-HTTLPR also predicted HR reactivity in sib-pair analyses among DZ twins.

CONCLUSIONS

These results suggest that the commonly observed sex difference in HR reactivity may be, in part, genetically mediated and perhaps occur only among individuals homozygous for the short allele at 5-HTTLPR.

Possible locus on chromosome 18q influencing postural systolic blood pressure changes

We conducted a genome-wide scan for quantitative trait loci influencing the systolic blood pressure, diastolic blood pressure, and pulse responses to a postural challenge in 498 white sibling-pairs from the Hypertension Genetic Epidemiology Network, a multicenter study of the genetic susceptibility to hypertension. All participants were hypertensive (systolic blood pressure >/=140 mm Hg, diastolic blood pressure >/=90 mm Hg, or on antihypertensive medications) with diagnosis before age 60. Blood pressure and pulse were measured by an oscillometric method after a 5-minute rest in a supine position and again immediately on standing. The genome scan included a total of 387 autosomal short-tandem-repeat polymorphisms typed by the National Heart, Lung, and Blood Institute Mammalian Genotyping Service at Marshfield. We used multipoint variance-components linkage analysis to identify possible quantitative trait loci influencing postural change phenotypes after adjusting for sex, age, and use of antihypertensive medications. There was suggestive evidence for linkage on chromosome 18q for the postural systolic blood pressure response (maximum logarithm of the odds score=2.6 at 80 centiMorgans). We also observed a maximum logarithm of the odds score of 1.9 for the systolic blood pressure response and 1.7 for the diastolic blood pressure response on chromosome 6p. The marker that demonstrated the strongest evidence for linkage for the systolic blood pressure response (D18S858) lies within 20 centiMorgans of a marker previously linked to rare familial orthostatic hypotensive syndrome. Our findings indicate that there may be 1 or more genes on chromosome 18q that regulate systolic blood pressure during the physiological recovery period after a postural stressor.

Segregation analysis of cardiovascular reactivity to laboratory stressors

To better understand the contribution of major gene influences to individual differences in cardiovascular reactivity, we performed a segregation analysis on blood pressure responses to two laboratory tasks, mental arithmetic and bicycle exercise. The study population consisted of 1,451 adults (age > or = 18 years) who were members of 81 Utah pedigrees. Only 864 members performed the bicycle task because persons age 60 years or older or with heart disease were excluded. Blood pressure reactivity to mental arithmetic was defined as change from resting values, and reactivity to the bicycle task was defined as the difference between maximum blood pressure during exercise and resting values adjusted for the individual's workload. Complex segregation analysis and likelihood procedures were used to test for a major gene effect controlling blood pressure reactivity to each task. Two modifiers of the penetrance, age and sex, were considered parameters in these models. We found that diastolic blood pressure (DBP) but not systolic blood pressure reactivities to the mental arithmetic and bicycle exercise tasks were controlled by major gene effects. The best-fitting model, however, differed for the two tasks. For DBP reactivity to mental arithmetic, a major codominant model with gene frequency 0.10 was the best-fitting model; for the bicycle task, the best-fitting model was a mixed recessive model with gene frequency 0.21. Sex differences in DBP reactivity were significant in both tasks: the effect of age was significant only for the mental arithmetic task. These results suggest a significant genetic component for DBP reactivity to laboratory stressors.

Four-year stability of cardiovascular reactivity to psychological stress

The 4-year stability of cardiovascular responses to laboratory psychological stress (mental arithmetic) was examined in 75 adults. The stability coefficients were .76 for heart rate (HR) change and .81 for absolute HR, .66 for systolic blood pressure (SBP) change and .52 for absolute SBP, .16 for diastolic blood pressure (DBP) change and .27 for absolute DBP. Males had greater SBP and DBP reactivity than females in the first session, but this reactivity decreased by the 4-year follow-up session (which was not the case for women).

Cardiovascular reactivity to stress and left ventricular mass in youth

We studied the relationships of cardiovascular reactivity during mental stress with left ventricular mass index in a group of prepubertal children 8 to 10 years old and in a group of peripubertal or postpubertal adolescents 15 to 17 years old. One hundred fifteen participants, varying in age group, sex, and race (black and white), took part in a laboratory stress protocol consisting of a reaction-time task, a mirror tracing task, a cold forehead challenge, and a stress interview. Cardiovascular measures included blood pressure and heart rate, as well as cardiac output, stroke volume, total peripheral resistance, and preejection period obtained noninvasively with impedance cardiography. Measures of left ventricular mass were made by echocardiography. Results indicated that across all participants, left ventricular mass index was associated with cardiovascular responses during the mirror tracing and cold forehead tasks, especially with those responses reflecting increased vasoconstriction. Subgroup analyses showed that these associations were significant for males and sometimes adolescents but not for females and children. As mirror tracing and cold forehead tasks most consistently produce alpha-adrenergic activation, the results suggest a model in which vasoconstriction due to mental stress is related to increased left ventricular mass in susceptible individuals, even at a young age.

Reproducibility of blood pressure and heart rate reactivity: a meta-analysis

Reproducibilities of blood pressure and heart rate (HR) reactivity reported in studies assessing responses to the same laboratory stressors across occasions were reviewed with meta-analytic techniques. Changes in HR had the greatest reproducibility (r = .555), followed by systolic blood pressure (SBP) (.407) and diastolic blood pressure (DBP) (.348). Both SBP and HR response reproducibility was higher at shorter test-retest intervals, whereas DBP values varied unsystematically with length of test-retest interval. Older samples exhibited higher SBP and DBP reproducibility to stressors. SBP and DBP reproducibilities were better for tasks that did not make speech demands. The reliability of reactivity assessment was higher when based on three or more measurements. On the basis of available evidence, the drop in stress reproducibility, as test-retest interval increases, places limits on the viability of BP reactivity as a strong marker or risk factor for coronary heart disease.

Temporal stability of acute stressor-induced changes in cellular immunity

This study examined the temporal stability of enumerative immune responses to acute psychosocial stress. Lymphocyte subsets were measured in 24 healthy male subjects at rest and following a speaking stressor on two occasions approximately six weeks apart. The speaking task caused significant increases in T-suppressor/cytotoxic cells, natural killer cells, T-cells, and total WBC and decreases in the T-helper/suppressor ratio. Baseline test-retest correlation's were statistically significant for all variables (r values = 0.40-0.90). With two exceptions (T-cells and T-suppressor/cytotoxic cells), speaking task values (absolute reactivity scores) were also statistically significant (r values = 0.48-0.92). Baseline adjusted test-retest correlations were however generally less reliable, with only natural killer cells (r values > 0.40), the T-helper/suppressor ratio (r = 0.60), and total WBC (r = 0.48) showing statistical significance. The findings suggest that certain but not all cellular immune responses to acute stress are moderately stable over time.

Temporal stability of heart period variability during a resting baseline and in response to psychological challenge

Central to the psychophysiologic reactivity hypothesis of the etiology of coronary artery disease is the assumption that reactivity is an individual characteristic that is stable over time. Although heart rate (HR) and blood pressure reactivity appear to meet this criterion, temporal stability of cardiac autonomic control as measured by analysis of heart period variability (HPV) has not been assessed. In this study, we tested the stability of HPV, measured in both the time and frequency domain, during a quiet, resting baseline and in response to 5-min mental arithmetic and reaction time tasks, in 20 normal subjects measured in three testing sessions during a 9-month period. Stability, assessed by the intraclass correlation coefficient (ICC), was excellent for resting baseline measures of HR and HPV, with ICCs of 0.68-0.86. However, HR and HPV reactivity to either arithmetic or reaction time tasks generally was less stable, with ICCs of 0.17-0.73, in contrast to results of previous studies demonstrating long-term stability of HR responses to psychological challenge. Stability of aggregated reactivity scores was only slightly improved. Whether for individual tasks or aggregated measures, reactivity of total and low-frequency measures of HPV was moderately stable but stability of high-frequency HPV reactivity was poor.

Touch relieves stress and pain

There are few systematic investigations of the potential benefits of incidental touch as it occurs in medical health care settings. In the present laboratory study 60 college students participated in two testing sessions 1 month apart. These sessions involved counterbalanced conditions of baseline, pulse palpation (touch), cold pressor test (stressor), and combined cold pressor/pulse palpation. Heart rate and systolic and diastolic blood pressure were measured during each condition. Subjective pain ratings were recorded during stress conditions. Significant decreases in cardiovascular measures and pain ratings were associated with physical contact. However, these changes were small and individual responses to physical contact were not stable over time. Physical contact produces a small but significant decrease in cardiovascular variables and the experience of pain. However, the tendency to show a cardiovascular response to touch does not represent a stable trait for individuals in the laboratory setting.

Familial influences on heart rate, blood pressure, and self-report anxiety responses to stress: results from 100 twin pairs

Two hundred healthy adolescent to middle-aged individuals (12-44 years, M = 20 years) were tested in a standardized stress protocol. These individuals comprised 20 monozygotic female, 20 monozygotic male, 20 same-sex dizygotic female, 20 same-sex dizygotic male, and 20 opposite-sex dizygotic twin pairs. Familial influences on heart rate, blood pressure, and self-report anxiety responses to four different kinds of stressors (Visual-Verbal Test for Conceptual Thought, mental arithmetic, isometric handgrip, cold pressor) were assessed using biometrical genetic model fitting. Evidence of significant genetic effects on resting heart rate and blood pressure was obtained, providing heritability estimates of .65, .63, and .58 for resting heart rate and systolic and diastolic blood pressure, respectively. Cardiovascular reactivity to the Visual-Verbal Test, mental arithmetic, and the cold pressor test appeared to be primarily influenced by genetic and idiosyncratic (nonfamilial) environmental factors, whereas reactivity to handgrip was more related to effects of the family environment. The results of multivariate model fitting suggested that the genetic effects on reactivity were relatively independent of those affecting resting heart rate and blood pressure and that there was significant overlap of genetic influences on heart rate and blood pressure responses to the two active coping tasks.

Temporal stability of task-induced cardiovascular, adrenergic, and psychological responses: the effects of race and hypertension

This study examined the test-retest reliability of task-induced responses of blood pressure, heart rate, norepinephrine, epinephrine, anger, and anxiety in 98 black and white normotensive and hypertensive individuals. Subjects completed three laboratory tasks (standing, mental arithmetic, and cold pressor) on two occasions 10 days apart. For all subjects, all baseline and test-retest correlation coefficients were significant (rs = .23-.71; median = .58). Baseline-adjusted (residual scores) reactivity test-retest correlation coefficients were consistently smaller (rs = .02-.55; median = .36). In contrast to the white hypertensives, white normotensives, and black normotensives, the black hypertensives showed no significant baseline-adjusted test-retest correlation coefficients (rs = -.21-.40; median = .12). Epinephrine responses revealed a significant session by race interaction; blacks had 20% higher mean values and whites had 10% lower mean values upon retesting. The data suggest that race and hypertension may interact to affect the temporal stability of task-induced responses to stressors.

Laboratory reactivity assessment: effects of casual blood pressure status and choice of task difficulty

In a study of 60 healthy young men, 26 with high and 34 with normal casual systolic pressure, blood pressure and its underlying hemodynamic determinants were measured at rest and during exposure to a series of laboratory tasks. Subjects were given a choice of performing either a difficult or an easy version of a mental arithmetic task, and then offered a similar choice of an easy or difficult stimulated public speaking task. All subjects were given the same tasks, regardless of choice, but led to believe the tasks were the ones they had chosen. During all tasks, subjects with high casual systolic pressure showed greater blood pressure, cardiac output, heart rate and myocardial contractility increases than subjects with normal casual pressure. Within the high casual pressure group, subjects who chose difficult for the mental arithmetic task exhibited greater increases in systolic pressure and heart rate during that task than subjects who chose easy. This subgroup maintained their greater responses during a subsequent mental arithmetic task in which all subjects were told that the difficulty level was the reverse of what they had initially chosen. Choosing difficult on the speaking task was associated with greater increases in cardiac output during performance on that task. Differences in cardiovascular responses associated with choice of difficulty were not evident during performance on tasks which did not pertain to the choice. For mental arithmetic, choice of difficulty was also associated with the psychological trait, fear of failure. These findings are relevant to the development of cardiovascular reactivity assessment procedures, which should attempt to detect psychological as well as physiological determinants of individual differences.

Temporal stability of the hemodynamics of cardiovascular reactivity

Cardiovascular responses to a competitive reaction-time task were monitored in 13 male subjects tested twice, 3 months apart. The temporal stability of blood pressure responses was in line with previous reports. However, in this study impedance cardiography permitted the investigation of the hemodynamic adjustments underlying the observed blood pressure responses. Analyses revealed that cardiac output and total peripheral resistance responses displayed temporal stability, indicating that subjects' blood pressure responses on the two occasions were the result of similar hemodynamic responses. These data thus extend the literature by demonstrating that the hemodynamic response pattern itself represents a stable individual difference variable.

Individual differences in heart rate response during behavioral challenge

This program of experiments examined heart rate responses to mental arithmetic and a video game. Attention first focused on their metabolic relevance. Comparison with heart rate/oxygen consumption regression equations generated from isotonic exercise data revealed that the heart rate increases of certain individuals were considerably in excess of those necessitated by contemporary metabolic demand. Both temporal and intertask consistency of reaction were explored, and supportive evidence was obtained. The relationship between laboratory and real-world reactions was investigated, and preliminary evidence found suggesting that in-laboratory responses are indicative of responses to more naturalistic stressors. Finally, twin studies examining the genetic and environmental determinants of individual differences in heart rate change during the tasks revealed a substantial genetic component for these responses.