Adaptive behavior in stressful situations and stroke incidence in hypertensive men - Results from prospective cohort study "men born in 1914" in Malmo, Sweden
L. Andre-petersson et al., Adaptive behavior in stressful situations and stroke incidence in hypertensive men - Results from prospective cohort study "men born in 1914" in Malmo, Sweden, STROKE, 32(8), 2001, pp. 1712-1717
Background and Purpose-Although hypertension is a major risk factor for str
oke, many hypertensive persons remain healthy. The aim of the present study
was to analyze whether adaptation in a stressful situation was associated
with the incidence of stroke in hypertensive
Methods-Two hundred thirty-eight hypertensive men were followed from baseli
ne in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation
to stress was studied with the serial Color-Word Test. In the Regression d
imension, 4 patterns of adaptation could be distinguished according to mast
ering of the test. Successful mastering of the test was shown in stabilized
patterns, increasing difficulty in cumulative patterns, fluctuating diffic
ulty in dissociative patterns, and fluctuating difficulty that increased du
ring testing in cumulative-dissociative patterns. The patterns were compare
d regarding stroke incidence.
Results-Forty-three men experienced a stroke during follow-up. Stroke rates
per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for
men with cumulative patterns, 16.2 for men with dissociative patterns, and
31.2 for men with cumulative-dissociative patterns. Multivariate analysis,
adjusted for relevant cerebrovascular risk factors, showed that the cumula
tive-dissociative pattern of the Regression dimension was associated with a
n increased risk of stroke during follow-up (relative risk 3.00, 95% Cl 1.3
2 to 6.81).
Conclusions-The specific behavior pattern, characterized by the greatest di
fficulties in managing the test, was associated with incidence of stroke in
hypertensive men. One interpretation is that hypertensive men who chronica
lly fail to find successful strategies in stressful situations are vulnerab
le to the damaging effects of stress and thereby at an increased risk of a
future stroke.