Adaptive behavior in stressful situations and stroke incidence in hypertensive men - Results from prospective cohort study "men born in 1914" in Malmo, Sweden

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.