PRESSOR REACTIONS TO PSYCHOLOGICAL STRESS AND PREDICTION OF FUTURE BLOOD-PRESSURE - DATA FROM THE WHITEHALL-II STUDY

Objective-To examine whether reactions of blood pressure to future blo od pressure. Design-Blood pressure was recorded at a medical screening examination after which presser reactions to a psychological stress t ask were determined. Follow up measurement of blood pressure was under taken, on average, 4.9 years later. Setting-20 civil service departmen ts in London. Subjects-1003 male civil servants aged between 35 and 55 years at entry to the study. Main outcome measure-Blood pressure at f ollow up screening. Results-Reactions of systolic blood pressure to st ress correlated positively with systolic blood pressure at follow up s creening (r = 0.22, P < 0.01). The dominant correlate of follow up blo od pressure was blood pressure at initial screening (r = 0.60 P < 0.01 between initial and follow up systolic blood pressure; r = 0.59, P < 0.01 between initial and follow up diastolic blood pressure). Stepwise multiple regression analysis indicated that reactions to the stressor provided minimal prediction of follow up blood pressure over and abov e that afforded by blood pressure at initial screening. In the case of follow up systolic blood pressure, systolic reactions to stress accou nted for only 1% of follow up variance; systolic blood pressure at ini tial screening accounted for 34%. With regard to diastolic blood press ure at follow up, the independent contribution from diastolic reaction s to stress was less than 1%. Conclusion-Pressor reactions to psycholo gical stress provide minimal independent prediction of blood pressure at follow up. Measurement of reactivity is not a useful clinical index of the course of future blood pressure.