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Relationship of Clinic, Ambulatory, and Laboratory Stress Blood Pressure to Left Ventricular Mass in Overweight Men and Women With High Blood Pressure

From the Departments of Psychiatry and Behavioral Sciences (A.S., E.C.D.G., A.G., M.B., J.A.B.) and Medicine (R.A.W.), Duke University Medical Center, Durham, NC, and the Department of Medicine (A.L.H.), University of North Carolina, Chapel Hill, NC.

Address reprint requests to: Andrew Sherwood, PhD, Box 3119, Duke University Medical Center, Durham, NC 27710; Fed Ex/UPS address: Room 4569, Duke Hospital South, Trent Drive, Durham, NC 27710, Email: Andrew.Sherwood{at}duke.edu

OBJECTIVE: This study was designed to evaluate the relationship between left ventricular (LV) mass and blood pressure (BP) recorded in the following contexts: in the clinic, using standard auscultatory procedures, during a typical day using ambulatory BP monitoring, and in the laboratory environment during behavioral stress testing.

METHODS: Ninety-seven men and women with clinic systolic blood pressure (SBP) of 130 to 180 mm Hg and/or diastolic blood pressure (DBP) of 85 to 110 mm Hg and mild to moderate obesity were included in the study. Laboratory stressors included the following tasks: Public Speaking; Anger Interview; Mirror Trace; and Cold Pressor. LV mass was measured using echocardiography and adjusted for body size by dividing by height^2.7 to yield LV mass index (LVMI).

RESULTS: LVMI was positively correlated with clinic SBP (r = 0.24, p < .05), ambulatory SBP (r = 0.34, p < .01), and aggregated laboratory stress SBP (r = 0.28, p < .01). Of the individual stressors, only SBP responses to the Mirror Trace and Cold Pressor tasks were independently correlated with LVMI (r = 0.35 and 0.34, respectively, p values < .01). Hierarchical regression analyses revealed that laboratory stress SBP remained a significant predictor of LVMI, after controlling for BMI and clinic pressure.

CONCLUSIONS: These findings suggest that cardiovascular responses to behavioral stress are associated with individual differences in LVMI in men and women with high blood pressure who are overweight. Laboratory studies of behavioral stress may help promote our understanding of the pathophysiology of LVH.

Key Words: left ventricular mass, • ambulatory blood pressure, • psychological stress, • hypertension.

Abbreviations: SBP = systolic blood pressure;; DBP = diastolic blood pressure;; LVMI = left ventricular mass index;; LVH = left ventricular hypertrophy;; SVRI = systemic vascular resistance index;; HR = heart rate;; CI = cardiac index;; BMI = body mass index.