Stress-induced blood pressure reactivity and incident stroke in middle-aged men

Background and Purpose - Exaggerated blood pressure reactivity to stress is associated with atherosclerosis and hypertension, which are known stroke r isk factors, but its relation to stroke is unknown. Previous work also indi cates that the association between reactivity and cardiovascular diseases m ay be influenced by socioeconomic status. Methods - The impact of blood pressure reactivity and socioeconomic status on incident stroke was examined in 2303 men (mean age, 52.8 +/-5.1 years) f rom a population-based, longitudinal study of risk factors for ischemic hea rt disease in eastern Finland. Reactivity was calculated as the difference between blood pressure measured during the anticipatory phase of an exercis e tolerance test (before exercise) and resting blood pressure, measured 1 w eek earlier. Mean systolic reactivity was 20 mm Hg (+15.9), and mean diasto lic reactivity was 8.6 mm Hg (+8.5). Socioeconomic status was assessed as y ears of education. One hundred thirteen incident strokes (90 ischemic) occu rred in 11.2 (+1.6) years of follow-up. Results - Men with exaggerated systolic reactivity (greater than or equal t o 20 mm Hg) had 72% greater risk of any stroke (relative hazard ratio [RH], 1.72; 95% CI, 1.17 to 2.54) and 87% greater risk of ischemic stroke (RH, 1 .87; 95% CI, 1.20 to 2.89) relative to less reactive men. Moreover, men who were high reactors and poorly educated were nearly 3 times more likely to suffer a stroke than better educated, less reactive men (RH, 2.90; 95% CI, 1.66 to 5.08). Adjustment for stroke risk factors had little impact on thes e associations. Diastolic reactivity was unrelated to stroke risk. Conclusions - Excessive sympathetic reactivity to stress may be etiological ly important in stroke, especially ischemic strokes, and low socioeconomic status confers added risk.