High stress responsivity predicts later blood pressure only in combinationwith positive family history and high life stress

High cardiovascular responsivity to stressors has not consistently improved prediction of later blood pressure increases beyond the predictive effects of baseline pressure. Animal models suggest that genetic susceptibility to hypertension and frequent stress exposure are important modulating factors in stress-related hypertension. Thus in 103 men originally tested at age 1 8 to 22 years and reassessed 10 years later, interactive effects of genetic susceptibility (defined as 1 or more hypertensive parents) with high stres s responsivity (defined as top 25% on the basis of blood pressure and cardi ac responses during both reaction time and cold presser tasks) were examine d in relation to follow-up systolic and diastolic levels and to change in b lood pressure status from normal (diastolic<80 mm Hg) to marginally elevate d (diastolic 85 to 95 mm Hg). Men with the combination of high stress respo nse and hypertensive parents demonstrated higher systolic (P<0.05) and dias tolic levels (P<0.05) at follow-up, and they showed a 7-fold increase (7.5, 95% confidence intervals 2.3, 24.3; P<0.001) in relative risk of change in blood pressure status versus men with no family history and a 3-fold incre ase (3.8, confidence intervals 1.5, 9.6; P<0.004) versus less stress-respon sive men who also had hypertensive parents. In 65 men who also provided rat ings of daily stress, family historyXstress responsivityXdaily stress inter actions were significant in predicting follow-up systolic and diastolic lev els (P<0.006 and 0.03, respectively), with highest pressure levels seen whe n high life stress was reported by high stress responders and/or men with h ypertensive parents. In conclusion, results suggest that stress responsivit y as a long-term predictor is modulated by both genetic and environmental f actors.