Blood pressure reactions to stress and the prediction of future blood pressure: Effects of sex, age, and socioeconomic position

Objective: This epidemiological study examined whether the magnitude of blood pressure reactions to mental stress was associated with future blood pressure and whether the strength of association was affected by sex, age, and socioeconomic position. Materials and Methods: Resting blood pressure was recorded at initial baseline and in response to mental stress. Five-year follow-up resting blood pressure data were available for 990 (68%) of the participants; 333 were 23 years old at the time of stress testing, 427 were 43, and 230 were 63. There were 541 women and 449 men, 440 came from manual and 550 from nonmanual occupation households. Results: Systolic blood pressure reactions to stress correlated positively with follow-up systolic blood pressure; no association was found for diastolic blood pressure reactions and follow-up diastolic blood pressure. In multivariate tests, systolic reactivity remained predictive of follow-up systolic blood pressure and accounted for 2.3% of the variance not explained by age, body mass index, and initial baseline systolic blood pressure. Systolic and diastolic reactivity predicted 5-year upward drift in systolic and diastolic blood pressure respectively, accounting for an additional 3.6% and 2.9% of variance, respectively, in multivariate models. The predictive value of reactivity was greater for participants from manual occupation households and tended to be greater for men. Conclusions: The results of this study indicate that blood reactions to mental stress predict future blood pressure status and the increase in resting blood pressure over time. The magnitude of the prediction appears to vary with socioeconomic position and sex.