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(Circulation. 2004;110:74-78.)
© 2004 American Heart Association, Inc.

Original Articles

Blood Pressure Reactivity to Psychological Stress Predicts Hypertension in the CARDIA Study

Karen A. Matthews, PhD; Charles R. Katholi, PhD; Heather McCreath, PhD; Mary A. Whooley, MD; David R. Williams, PhD, MPH; Sha Zhu, PhD; Jerry H. Markovitz, MD, MPH

From the University of Pittsburgh, Pittsburgh, Pa (K.A.M.); University of Alabama, Birmingham (C.R.K., H.M., S.Z.); University of California, San Francisco (M.A.W.); and University of Michigan, Ann Arbor (D.R.W.).

Correspondence to Karen A. Matthews, PhD, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA. E-mail matthewska{at}upmc.edu

Received August 25, 2003; de novo received January 21, 2004; accepted March 13, 2004.

Background— A longstanding but controversial hypothesis is that individuals who exhibit frequent, large increases in blood pressure (BP) during psychological stress are at risk for developing essential hypertension. We tested whether BP changes during psychological stress predict incident hypertension in young adults.

Methods and Results— We used survival analysis to predict hypertensive status during 13 years of follow-up in a sample of >4100 normotensive black and white men and women (age at entry, 18 to 30 years) enrolled in the CARDIA study. BP responses to 3 psychological challenges—cold pressor, star tracing, and video game tasks—were measured. Hypertensive status was defined as use of antihypertensive medication or measured BP 140/90 mm Hg. After adjustment for race, gender, covariates (education, body mass index, age, and resting pressure), and their significant interactions, the larger the BP responses were to each of the 3 tasks, the earlier hypertension occurred (P<0.0001 to <0.01). The systolic BP effect for the cold pressor task was apparent for women and for whites in race- and gender-specific models, whereas the diastolic BP effect for the video game was apparent for men.

Conclusions— Young adults who show a large BP response to psychological stress may be at risk for hypertension as they approach midlife.

Key Words: hypertension • risk factors • stress

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