Correspondence between laboratory and ambulatory measures of cardiovascular reactivity: a multilevel modeling approach

We examined the correspondence between laboratory measures of cardiovascular reactivity (CVR) and within-person changes in cardiovascular activity during the challenges of daily life, after adjustment for posture, activity, and other effects. Healthy adults (n = 335) were administered laboratory measures of CVR along with 6 days of ambulatory blood pressure monitoring and electronic diary reports. Compared with low reactors, high laboratory systolic blood pressure (SBP) reactors showed larger increases in SBP during periods of high task demand or low decisional control in daily life. High diastolic blood pressure (DBP) reactors showed larger increases in ambulatory DBP during situations rated as both low control and high demand. This multilevel modeling approach may enhance our ability to detect the correspondence between laboratory and ambulatory measures of CVR, and to identify the circumstances under which it may be most clearly observed.     

A Change of Heart: Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict

This study sought to examine the psychophysiological correlates of forgiveness in response to interpersonal conflict. One hundred eight college students (44 males and 64 females) participated in two interviews about times of interpersonal betrayal, one about a parent and one about a friend/partner. Measures of forgiving personality and state forgiveness were collected, as well as stress, hostility, empathy, and self-reported illness symptoms. During baseline, interviews and recovery periods, repeated measures were taken of blood pressure, heart rate, frontalis EMG, and skin conductance. Trait forgiveness was associated with lower levels of blood pressure. State forgiveness was associated with lower blood pressure levels, heart rate, and rate pressure product. Acute, stress-induced reactivity was also linked to forgiveness: state forgiveness was associated with diastolic and mean arterial pressure and rate pressure product reactivity during the parent interview. Increased blood pressure recovery after stress was also linked to trait forgiveness. Forgiveness may produce beneficial effects directly by reducing allostatic load associated with betrayal and conflict, and indirectly through reductions in perceived stress.     

Social support schemas, trait anger, and cardiovascular responses.

This study examined the influence of activated support schemas on cardiovascular reactivity (CVR) during an anger-recall interview. Eighty Chinese female undergraduates wrote about a supportive tie or a casual acquaintance and subsequently disclosed an anger-provoking event while their heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Compared to participants in the 'acquaintance' condition, those in the 'support' condition showed lower HR, SBP and DBP reactivity, as well as smaller state anger increases and less negative appraisals of the recalled anger event. Reactivity increased as a function of trait anger. High trait anger individuals also had greater increases in state anger and more negative appraisals of the recalled event compared to their low trait anger counterparts. Support schema activation reduced the effects of trait anger on CVR such that high trait anger individuals in the 'support' condition had significantly lower CVR compared to high trait anger individuals in the 'acquaintance' condition. These findings suggest that social support schemas may have beneficial effects even in the absence of actual, enacted support.     

Vagal rebound and recovery from psychological stress

OBJECTIVE: To characterize cardiovascular recovery and examine the possible relationship of vagal activity and reflexes to risk for heart disease. METHODS: Subjects performed cold pressor and mental arithmetic tasks. Heart rate, heart period variability, and pre-ejection period were obtained for 1 minute before, during, and after each task (Experiment 1). In the second experiment, subjects performed a Stroop color-word task and a mental arithmetic task. Heart rate, heart period variability, blood pressure, and baroreflex sensitivity were obtained during the 5-minute baseline, task, and recovery periods (Experiment 2). RESULTS: In Experiment 1, heart rate during recovery was lower than baseline despite continued pre-ejection period shortening, whereas recovery heart period variability was higher than baseline. In Experiment 2, blood pressure increased throughout the session. However, recovery heart rate after mental arithmetic was lower than baseline heart rate, and heart period variability was higher during both recovery periods than during baseline. Vagal rebound, a sharp increase in variability in the first minute of recovery, was reduced in men in Experiment 1 and in individuals with a family history of cardiovascular disease in Experiment 2 and was associated with degree of change in baroreflex sensitivity between task and rest. CONCLUSIONS: Cardiovascular recovery from stress is associated with increased vagal modulation despite residual sympathetic activation. Vagal rebound may be involved in mechanisms resetting the baroreflex sensitivity at the onset and offset of stress. Diminished vagal rebound during recovery from stress is associated with standard risk factors for cardiovascular disease. The results support an association between attenuated vagal reflexes and risk for cardiovascular disease.     

Laboratory-based blood pressure recovery is a predictor of ambulatory blood pressure

The recovery phase of the stress response is an individual difference characteristic that may predict cardiovascular risk. The purpose of this study was to examine whether laboratory-based blood pressure (BP) recovery predicts ambulatory BP (ABP). One hundred and eighty-two participants underwent a standard laboratory stress protocol, involving a 20-min baseline rest period, and four stressors presented in a counterbalanced order, each followed by a 10-min recovery period. Participants also wore an ABP monitor for 24h during a typical workday. Hierarchical regression analyses showed that BP recovery accounted for significant additional variance for daytime SBP (p<0.001), nighttime SBP (p<0.001), daytime DBP (p<0.001), and nighttime DBP (p<0.001), after controlling for baseline and reactivity BP. Results suggest that persistence of the BP response following stress may be a more salient characteristic of the stress response in understanding its potential impact on longer term cardiovascular regulation.     

Heart rate, neuroendocrine, and immunological reactivity in response to an acute laboratory stressor

OBJECTIVE: The primary objective of the present study was to identify neuroendocrine and immunological correlates of cardiovascular reactivity to an acute laboratory stressor. METHODS: Subjects were 56 healthy volunteers. Heart rate and blood pressure were assessed at regular intervals during a 30-minute adaptation period and a 6-minute videotaped speech task. Blood was drawn before and after the task and was assayed for natural killer cell activity (NKCA), cortisol production, in vitro interferon gamma (IFN-gamma) and interleukin 10 production by peripheral blood mononuclear cells (PBMC), and antibody titers to the Epstein-Barr virus. Psychological measures were also administered. RESULTS: NKCA increased significantly in response to the task, and this increase was significantly and positively correlated with heart rate reactivity. IFN-gamma production by PBMC also increased in response to the task, but these increases were unrelated to heart rate reactivity. In addition, baseline cortisol levels were found to be predictive of heart rate reactivity. Finally, questionnaire data were modestly related to various aspects of stress-induced reactivity. CONCLUSIONS: Consistent with the task-related increases in NKCA and IFN-gamma, acute stress may signal an increase in at least some aspects of the cell-mediated, or TH1-driven, immune response. Furthermore, the finding that heart rate reactivity was related in part to baseline individual differences in cortisol production suggests that short-term cardiovascular responses to stress may be directly related to longer-term neuroendocrine modulation. Finally, the present results also help to highlight the influence of both sympathetic and nonsympathetic pathways in the response to acute stressors and suggest tentative links between certain psychological traits and various aspects of stress-induced reactivity.     

Sociotropic Cognition Moderates Stress-Induced Cardiovascular Responsiveness in College Women

This study examined the moderating effects of sociotropic cognition (SC), a nondefensive need for approval, on stress-induced cardiovascular responsiveness (CVR) in women. Sixty-seven college-age females had blood pressure (BP) and heart rate (HR) monitored during baseline, anticipation, story-telling (where participants were randomly assigned to a low or high threat condition), and recovery periods. SC showed a positive association with CVR only in the high interpersonal threat context during task and early stages of the recovery periods. SC was positively correlated with such variables as anxiety, ruminative style, dysphoria, and anger. This is the first report examining the moderating effects of SC on interpersonal stress-induced CVR prior to, during, and following a task, using an explicit manipulation of social evaluation. The data help define risk factors for CVR in women, which may aid in the understanding of how emotions and stress affect physical health and well-being.     

The influence of trait and state rumination on cardiovascular recovery from a negative emotional stressor

The purpose of this study was to evaluate the influence of trait and state rumination on cardiovascular recovery following a negative emotional stressor. Cardiovascular data was collected from 64 undergraduate women during a 10-min baseline period, 5-min emotional recall stress task, and a 15-min recovery period. Trait rumination was assessed using the Stress Reactive Rumination Scale and state rumination was assessed 5 and 10 min after the stressor, using a thought-report technique. Results indicated that trait and state rumination interacted such that low trait ruminators who were ruminating at 10 min after the termination of the stressor had poorer diastolic blood pressure and high-frequency heart rate variability recovery compared to low trait ruminators who were not ruminating. State rumination was not associated with cardiovascular recovery in high trait ruminators. Results suggest that rumination may play a role in the association between stress and hypertension by prolonging cardiovascular activation following stress.     

Cardiovascular reactivity during public speaking as a function of personality variables.

An experiment was conducted to assess the effects of a real-life stressor (public speaking) upon cardiovascular reactivity (CVR). Changes in blood pressure and heart rate from baseline to task were measured in a sample of 86 men and women. The purpose was to examine the effects of individual differences (Type A personality, hostility and gender) on CVR. Participants gave a 6-min oral presentation during which they were evaluated by their professor and with classmates as the audience. Results indicated that all participants had marked CVR during public speaking. There were differences in reactivity patterns between men and women, but personality did not play a role except for high hostile men. It is suggested that intense stressors may result in high levels of CVR independent of personality variables that moderate reactivity at lower levels of stress.     

An alternative approach for achieving cardiovascular baseline: viewing an aquatic video.

Due to the importance of baseline and recovery levels in the computation of reactivity, two studies were conducted to determine an alternative method to traditional rest for achieving baseline and recovery levels of cardiovascular measurements. Watching a relaxing, aquatic video was compared with a traditional resting baseline to determine the better method for achieving low baseline levels. In addition, watching the video was compared with traditional rest during 5-min post-task recovery periods. Systolic (SBP) and diastolic blood pressure (DBP) decreased more during the baseline period when subjects viewed the video than when subjects rested quietly. Similarly, subjects displayed greater recovery following the mental tasks when they watched a video than when they merely sat quietly. It is recommended that researchers standardize baseline procedures by showing a relaxing video before administering tasks for the assessment of cardiovascular reactivity.     

The influence of forgiveness and apology on cardiovascular reactivity and recovery in response to mental stress

To investigate the relation between forgiveness and apology as they relate to cardiovascular reactivity and recovery, 29 men and 50 women were exposed to an interpersonal transgression (i.e., verbal harassment) while performing a serial subtraction task. Participants were categorized into high and low forgiveness groups based on scores on the forgiving personality scale. Following the task, approximately half of the participants received an apology from the experimenter for his/her comments during the task. Although no group differences in cardiovascular reactivity were observed during the serial subtraction task, persons high in forgiveness displayed more rapid diastolic and mean arterial blood pressure recovery than persons low in forgiveness. In response to the apology, participants displayed greater high frequency heart rate variability recovery compared to those who did not receive an apology. A significant apology × sex interaction was observed for diastolic blood pressure and mean arterial blood pressure. Women who received an apology exhibited faster recovery from the transgression than women who did not receive an apology. In contrast, men who received an apology exhibited delayed recovery from the transgression compared to men who did not receive an apology. These results indicate that there are potentially healthful benefits to forgiveness and apology, but the relation is influenced by situation and by sex.     

Interactive effects of traits,states, and gender on cardiovascular reactivity during different situations

Interactive effects of anger and anxiety traits, negative affect state, different situations, and gender on cardiovascular reactivity (CVR) to stress were examined. Subjects (91 men, 92 women) performed a reaction time task under either a Social Evaluation, a Harassment, or a Control condition; SBP, DBP, and HR were recorded continuously. Hierarchical multiple regressions revealed intricate interactions. The interaction of anger expression style and anger experience was significant only among men, such that anger suppressors with high trait anger showed the largest CVR of any group during Harassment; anger expressors exhibited generally high CVR across conditions. However, anger expression style and state negative affect interacted to affect CVR in both men and women. Finally, the fear of negative evaluation predicted elevated DBP responses only among men in the Social Evaluation condition. Results imply that the extent to which traits of anger and anxiety contribute to coronary risk may depend on interactions with other traits, gender, and the environment.     

The Unique Effects of Forgiveness on Health: An Exploration of Pathways

The relationship of forgiveness, both state and trait, to health was assessed. Eighty-one community adults completed a packet of questionnaires and participated in a laboratory interview about a time of hurt or betrayal. Heart rate and blood pressure were recorded during a 10 min baseline, the interview and during a recovery period; interviews were structured around a framework of questions and videotaped. Four measures of forgiveness were all statistically associated with five measures of health (physical symptoms, medications used, sleep quality, fatigue, and somatic complaints). Trait forgiveness was associated with decreased reactivity (rate-pressure product) to the interview, but sympathetic reactivity did not account for the trait forgiveness–health association. Four mechanisms or pathways by which forgiveness could lead to fewer physical symptoms were examined: spirituality, social skills, reduction in negative affect, and reduction in stress. All factors either partially or fully mediated the effect of forgiveness on health; however, the strongest mediator for both state and trait forgiveness was reduction in negative affect. For state forgiveness, the second strongest mediator was reduction in stress; for trait forgiveness, both conflict management and reduction in stress were strong contributors.     

Depressive symptoms and cardiovascular reactivity to laboratory behavioral stress

Although a growing literature associates depressive symptoms with cardiovascular disease (CVD), the mechanisms underlying this association have not been clearly determined. The cardiovascular reactivity (CVR) hypothesis suggests that chronically elevated CVR during psychological distress can confer disease risk via vascular alterations. This investigation is a quantitative review of studies that evaluated the association of depressive symptoms with CVR. Atotal of 60 hypotheses were tested: 21 tests involved systolic blood pressure (SBP), 21 involved diastolic blood pressure (DBP), and 18 involved heart rate (HR). The aggregate effect size for the relation between depressive symptoms and HR reactivity was moderate (d = 0.37); aggregate effect sizes were small for SBP reactivity (d = 0.13) and DBP reactivity (d = 0.17). Effect sizes involving SBP reactivity were homogenous, whereas effect sizes involving DBP and HR reactivity were higher for studies that examined participants with CVD. These findings provide partial support for the associations of depressive symptoms with CVR.     

The immediate and delayed cardiovascular benefits of forgiving

Background The putative health benefits of forgiveness may include long-term buffering against cardiovascular reactivity associated with rumination. Although studies show short-term benefits of adopting a forgiving perspective, it is uncertain whether this perspective protects against repeated future rumination on offenses, which may be necessary for long-term health benefits. Also unclear is whether forgiveness offers unique benefits beyond simple distraction. Methods Cardiovascular parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], and heart rate) were measured while 202 participants thought about a previous offense from an angry or forgiving perspective or were distracted. All participants were then distracted for 5 minutes, after which they freely ruminated on the offense. Results Angry rumination initially yielded the greatest increase in blood pressure from baseline (mean [M] [standard deviation {SD}]: SBP = 9.24 [11.16]; M [SD]: DBP = 4.69 [7.48]) compared with forgiveness (M [SD]: SBP = 3.30 [6.48]; M [SD]: DBP = 1.51 [4.94]) and distraction (M [SD]: SBP = 4.81 [6.28]; M [SD]: DBP = 1.75 [3.80]), which did not differ from each other (p > .30). During free rumination, however, those who had previously focused on forgiveness showed less reactivity (M [SD]: SBP = 7.33 [9.61]; M [SD]: DBP = 4.73 [7.33]) than those who had been distracted (M [SD]: SBP = 10.50 [7.77]; M [SD]: DBP = 7.71 [6.83]) and those who previously focused on angry rumination (M [SD]: SBP = 12.04 [11.74]; M [SD]: DBP = 8.64 [12.63]). There were no differences for heart rate. Conclusions Forgiveness seems to lower reactivity both during the initial cognitive process and, more importantly, during mental recreations of an offense soon thereafter, potentially offering sustained protection, whereas effects of distraction appear transient.     

The effects of Neuroticism and Extraversion on cardiovascular reactivity during a mental and an emotional stress task

Evidence suggests that physiological reactivity to mental and emotional stress may be influenced by personality traits.ObjectivesThis study aimed to examine the relationship between, emotionally based personality traits, Neuroticism (N) and Extraversion (E), and cardiovascular reactivity (CVR) during mental arithmetic (MA) and anger recall (AR).MethodsHeart rate, blood pressure, cardiac output and total peripheral resistance were measured in 114 Singaporean male patrol officers from the Singapore Police Force while they performed MA and AR tasks. N and E were assessed using the NEO PI-R.ResultsHigher N was associated with lower DBP and TPRI reactivity during MA as compared to lower N, but higher TPRI reactivity during AR. Lower E scores were associated with heightened CVR while higher E scores were associated with lower CVR. For SBP and HR, E was associated with a reduction in reactivity across tasks; whereas, for DBP and TPRI this reduction was found only during AR.ConclusionIn this population, N had differential effects on CVR depending upon the nature of the stress task, cognitive or emotional. However, higher E was consistently linked to lower CVR during stress tasks and appeared to influence how individuals express and cope with anger.     

Cardiovascular reactivity of Singaporean male police officers as a function of task, ethnicity and hostility.

OBJECTIVE: This research examined hemodynamic processes in cardiovascular reactivity (CVR) as a function of task, ethnicity and trait hostility. METHOD: One hundred and fourteen male patrol officers from the Singapore Police Force participated in this experimental study. Trait hostility was measured using the interpersonal hostility assessment technique to derive a hostile behavior index (HBI). Heart rate, blood pressure and hemodynamic measures were taken while participants performed three tasks: mental arithmetic, number reading and anger recall (AR). RESULTS: AR elicited the greatest blood pressure, vascular and cardiac output reactivity. HBI scores were positively related to systolic blood pressure reactivity during AR for Malays whereas this was not true for Indians and Chinese. Across tasks Indians with high HBI scores appeared to be cardiac reactors whereas the reactivity patterns for Malays and Chinese were undifferentiated. Self-report of negative mood was not related to CVR. CONCLUSION: These results are consistent with the higher rates of coronary heart disease deaths among Indians as well as the higher rates for hypertension among Malays in Singapore.     

Psychological,situational, and gender predictors of cardiovascular reactivity to stress: A multivariate approach

This study examined whether relationships between anger expression, hostility, social evaluative anxiety, and a presumed mechanism for coronary heart disease development, cardiovascular reactivity (CVR) to stress, are moderated by stress situation and gender and whether such relationships are attenuated by inadequate assessments. Subjects (47 men, 47 women) were assigned randomly to either a Harassment or a Social Evaluation condition, under which they performed a reaction time task. SBP, DBP, and HR measures were recorded during baseline and task. Multiple regression analyses indicated that expressed anger was related to CVR only among men in the Harassment condition; that hostile men who express anger showed the most CVR across situations, and that the traits assessed here did not predict CVR among women. Results suggest that assessments of coronary-risk and interventions to reduce risk may need to take into account attitudes, styles of emotional expression, environmental factors, and gender.This research was supported in part by an NIMH predoctoral fellowship (F31MH09836) awarded to John W. Burns and by a grant from the American Heart Association (89-01-3G) awarded to Edward S. Katkin.     

Cardiovascular reactivity of younger and older adults to positive-, negative-, and mixed-emotion cognitive challenge

Although aging is associated with progressive increases in blood pressure level, previous research has been inconsistent as to whether older adults show greater or lesser cardiovascular reactivity (CVR) to emotion than do younger adults. There is reason to believe that these inconsistencies could be clarified by examining age-related differences in hemodynamic profile revealed by measuring the pattern of cardiac output and total peripheral resistance associated with changes in blood pressure reactivity. Accordingly, the present study examined the performance, CVR, and hemodynamic profile of younger and older adults during encoding and recognition of word pairs involving four valence types: positive, negative, mixed (positive/negative), and neutral word pairs. Results revealed higher baseline blood pressure, increased CVR characterized by a vascular hemodynamic profile, and more rapid recovery (especially during encoding) for older than for younger participants. Results are discussed in light of research and theory on the relationship between aging and cardiovascular health.     

Cardiovascular Responses to Stress: I. Measures of Myocardial Response and Relationship to High Resting Systolic Pressure and Parental Hypertension

A comparison of pre-ejection period (PEP), heart rate (HR), and systolic (SBP) and diastolk (DBP) blood pressure responses to the cold pressor test and a pseudo-shock avoidance reaction time task was performed in 183 young men. These tasks differ in the extent to which they evoke enhanced myocardial and vascular adrenergic activity. Decreases in PEP were more pronounced during the reaction time task, while DBP increased more during the cold pressor test. MR and SBP responses did not differentiate the two tasks. PEP decreases occurred in the absence of any apparent increase in cardiac preload or decrease in afterload. Parental hypertension as determined by physician reports was associated with higher SBP across all conditions. A subgroup of individuals (15%) showed SBP levels >140 mm Hg when typical clinical stethoscopic determinations were made, but less than half as many showed such elevations during a more extended resting baseline using remotely operated devices. High stethoscopic SBP was associated with greater cardiovascular responses to the stressors, while high SBP during the extended baseline was not.