Paper

Pressor reactions to psychological stress and prediction of future blood pressure: data from the Whitehall II study

BMJ 1995; 310 doi: 10.1136/bmj.310.6982.771 (Published 25 March 1995)
Cite this as: BMJ 1995;310:771
  1. Douglas Carroll, professor of psychologya,
  2. George Davey Smith, professor of clinical epidemiologyb,
  3. David Sheffield, research studenta,
  4. Martin J Shipley, senior lecturer in medical statisticsc,
  5. Michael G Marmot, professor of epidemiology and public healthc
  1. a Department of Psychology, Glasgow Caledonian University, Glasgow G4 0BA
  2. b Department of Epidemiology and Public Health Medicine, University of Bristol, Bristol BS8 2PR
  3. c Department of Epidemiology and Public Health, University College and Middlesex School of Medicine, University College London, London WC1E 6BT
  1. Correspondence to: Professor Carroll.
  • Accepted 12 January 1995

Abstract

Objective: To examine whether reactions of blood pressure to psychological stress predict future blood pressure.

Design: Blood pressure was recorded at a medical screening examination after which pressor reactions to a psychological stress task were determined. Follow up measurement of blood pressure was undertaken, on average, 4.9 years later.

Setting: 20 civil service departments in London.

Subjects: 1003 male civil servants aged between 35 and 55 years at entry to the study.

Main outcome measure: Blood pressure at follow up screening.

Results: Reactions of systolic blood pressure to stress correlated positively with systolic blood pressure at follow up screening (r=0.22, P<0.01). The dominant correlate of follow up blood pressure was blood pressure at initial screening (r=0.60; P<0.01 between initial and follow up systolic blood pressure; r=0.59, P<0.01 between initial and follow up diastolic blood pressure). Stepwise multiple regression analysis indicated that reactions to the stressor provided minimal prediction of follow up blood pressure over and above that afforded by blood pressure at initial screening. In the case of follow up systolic blood pressure, systolic reactions to stress accounted for only 1% of follow up variance; systolic blood pressure at initial screening accounted for 34%. With regard to diastolic blood pressure at follow up, the independent contribution from diastolic reactions to stress was less than 1%.

Conclusion: Pressor reactions to psychological stress provide minimal independent prediction of blood pressure at follow up. Measurement of reactivity is not a useful clinical index of the course of future blood pressure.

Key messages

  • Key messages

  • Reactions of blood pressure to psychological stress are less predictive of future blood pressure than either resting laboratory or casual blood pressure

  • Reactions of blood pressure to psychological stress afford minimal prediction of future blood pressure independently of initial blood pressure

  • Reactions of blood pressure to stress cannot be advocated as a useful clinical index of the course of future blood pressure

  • Reactions of blood pressure to psychological stress may have little or no role in the aetiology of hypertension

Footnotes

    • Accepted 12 January 1995

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