Dataset Information

Heightened Stress Reactivity in Response to an Attachment Related Stressor in Patients With Medically Treated Primary Hypertension.

ABSTRACT: Background: A heightened stress reactivity to mental stress tasks has been shown in hypertensive patients and might contribute to a higher disease risk. We investigated this hyperreactivity with regard to an attachment related stressor that focuses on emotions instead of performance and we examined whether this effect can also be found in patients on antihypertensive drugs. Materials and Methods: Fifty patients with primary hypertension, treated with at least one antihypertensive drug, were compared with 25 healthy individuals. After 10 min of rest, they participated in an attachment-related interview (Adult Attachment Projective picture system, AAP) and were exposed to an attachment-related stressor (Separation Recall, SR), a short-time stressor which activates attachment-related emotions and thoughts by talking 5 min about a personal experience of loneliness. Blood samples to measure adrenocorticotrope hormone (ACTH), cortisol, norepinephrine, epinephrine, and dopamine were taken. Blood pressure, heart rate and arterial stiffness were measured at rest, after AAP, after SR and 10 min after recovery. Standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive differences (RMSSD) were calculated. Parameters were compared using Mann Whitney U-test and linear mixed-effects regression models controlling for age and body mass index (BMI) after logarithmic transformation if appropriate. Results: Healthy test persons were younger and had lower BMI than patients. Comparing the two groups there were no significant differences in blood pressure and heart rate at rest. Both stressors provoked a significant response in almost all parameters. Results of the post-estimation of contrasts from linear mixed-effects regression models showed a steeper rise in systolic BP and arterial stiffness as well as a more pronounced decline in SDNN in hypertensive patients than in healthy controls. Levels of cortisol rose earlier and higher in hypertensive patients than in healthy controls. Conclusion: Vascular, autonomic, and hypothalamic pituitary adrenal axis response is heightened in medicated subjects with hypertension in response to attachment-focused stressors compared to healthy subjects. We conclude that the remaining hyper-reactivity even with sufficient antihypertensive medication still poses a substantial risk for affected patients. New ways to diminish this risk should be developed.

SUBMITTER: Balint EM

PROVIDER: S-EPMC8459015 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BACKGROUND:Childhood maltreatment is one of the most potent predictors of future psychopathology, including internalizing disorders. It remains unclear whether heightened amygdala reactivity to threat and elevated stress exposure may be implicated in the pathogenesis and maintenance of internalizing disorders among individuals with a history of childhood maltreatment. METHODS:Using data from a sample of 1,144 young adults, we investigated the contribution of baseline threat-related amygdala reactivity and prospective major stressful life events to internalizing symptoms severity 1 year later (on average) in individuals with a history of maltreatment (n = 100) and propensity score matched nonmaltreated peers (n = 96). RESULTS:Even after stringently matching for several potentially confounding variables - including baseline internalizing symptoms, socioeconomic status and IQ - childhood maltreatment status predicted increased amygdala reactivity at baseline, elevated post-baseline exposure to major stressful life events and internalizing symptoms at follow-up. We also showed, for the first time, that amygdala reactivity at baseline and also post-baseline exposure to major stressful life events mediated the association between a history of maltreatment and future internalizing symptoms. CONCLUSIONS:These findings provide support for the view that maltreatment is a potent developmental insult leading to long-lasting neurocognitive recalibrations of the threat processing system. It is possible that such alterations, over time, may impact mental health functioning by compromising the ability to effectively negotiate everyday challenges (stress susceptibility). These alterations were not, however, found to sensitize an individual to the impact of major stressful life events. The results of this study also lend compelling support to the view that increased psychiatric risk, in the context of childhood maltreatment, follows from an increased propensity to experience major stressful life events (stress generation).

Project description:BackgroundMineralocorticoid receptor (MR) antagonists are the recommended medical therapy for primary aldosteronism. Whether this recommendation effectively reduces cardiometabolic risk is not well understood. We aimed to investigate the risk of incident cardiovascular events in patients with primary aldosteronism treated with MR antagonists compared with patients with essential hypertension.MethodsWe did a cohort study using patients from a research registry from Brigham and Women's Hospital, Massachusetts General Hospital, and their affiliated partner hospitals. We identified patients with primary aldosteronism using International Classification of Disease, 9th and 10th Revision codes, who were assessed between the years 1991-2016 and were at least 18 years of age. We excluded patients who underwent surgical adrenalectomy, had a previous cardiovascular event, were not treated with MR antagonists, or had no follow-up visits after study entry. From the same registry, we identified a population with essential hypertension that was frequency matched by decade of age at study entry. We extracted patient cohort data and collated it into a de-identified database. The primary outcome was an incident cardiovascular event, defined as a composite of incident myocardial infarction or coronary revascularisation, hospital admission with congestive heart failure, or stroke, which was assessed using adjusted Cox regression models. Secondary outcomes were the individual components of the composite cardiovascular outcome, as well as incident atrial fibrillation, incident diabetes, and death.FindingsWe identified 602 eligible patients with primary aldosteronism treated with MR antagonists and 41 853 age-matched patients with essential hypertension from the registry. The two groups of patients had comparable cardiovascular risk profiles and blood pressure throughout the study. The incidence of cardiovascular events was higher in patients with primary aldosteronism on MR antagonists than in patients with essential hypertension (56·3 [95% CI 48·8-64·7] vs 26·6 [26·1-27·2] events per 1000 person-years, adjusted hazard ratio 1·91 [95% CI 1·63-2·25]; adjusted 10-year cumulative incidence difference 14·1 [95% CI 10·1-18·0] excess events per 100 people). Patients with primary aldosteronism also had higher adjusted risks for incident mortality (hazard ratio [HR] 1·34 [95% CI 1·06-1·71]), diabetes (1·26 [1·01-1·57]), and atrial fibrillation (1·93 [1·54-2·42]). Compared with essential hypertension, the excess risk for cardiovascular events and mortality was limited to patients with primary aldosteronism whose renin activity remained suppressed (<1 μg/L per h) on MR antagonists (adjusted HR [2·83 [95% CI 2·11-3·80], and 1·79 [1·14-2·80], respectively) whereas patients who were treated with higher MR antagonist doses and had unsuppressed renin (≥1 μg/L per h) had no significant excess risk.InterpretationThe current practice of MR antagonist therapy in primary aldosteronism is associated with significantly higher risk for incident cardiometabolic events and death, independent of blood pressure control, than for patients with essential hypertension. Titration of MR antagonist therapy to raise renin might mitigate this excess risk.FundingUS National Institutes of Health.

Dataset Information

Heightened Stress Reactivity in Response to an Attachment Related Stressor in Patients With Medically Treated Primary Hypertension.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets