Reactivity as a predictor of subsequent blood pressure: racial differences in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Abstract

This study investigated the association between cardiovascular reactivity and subsequent ambulatory blood pressure in 316 black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Cardiovascular laboratory reactivity was examined in subjects 20 to 33 years old, and ambulatory blood pressure and heart rate were measured 3 years later. Average ambulatory pressure during a 24-hour period was regressed separately on stress reactivity and standard covariate risk factors in each race/gender subgroup. Blacks had higher blood pressure and heart rates than whites, men had higher blood pressure than women, and women had higher heart rates than men. After controlling for age, baseline systolic pressure, familial history of hypertension, smoking, alcohol consumption, body mass index, and exercise, systolic blood pressure reactivity to star tracing and cold pressor stress were significantly associated with systolic ambulatory pressure in black men and women 3 years later (partial r=0.24 to 0.37). Heart rate reactivity to video challenge and star tracing were also significantly predictive of subsequent ambulatory heart rate in blacks. Diastolic star tracing reactivity was significantly associated with subsequent ambulatory blood pressure in black women (r=0.23), and diastolic reactivity to video and star tracing were significantly predictive of ambulatory diastolic pressure in white men (r=0.39). We conclude that hyperresponsivity to stress may be a risk factor for subsequent blood pressure elevation in blacks and may be one pathway leading to the higher prevalence of hypertension in blacks than in whites.