Abstract 17321: Race Differences in Hemodynamic Responses to Acute Mental Stress and the Role of Depressive Symptoms

• Published in: Circulation (New York, N.Y.) Vol. 130; no. suppl_2
• Main Authors: Wilmot, Kobina A, Al Mheid, Ibhar, Ramadan, Ronnie, Pimple, Pratik M, Shah, Amit J, Alkhoder, Ayman, Obideen, Malik, Kutner, Michael, Long, Qi, Lewis, Tene`, Raggi, Paolo, Bremner, Douglas, Quyyumi, Arshed A, Vaccarino, Viola
• Format: Journal Article
• Language: English
• Published: 25.11.2014
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.130.suppl_2.17321

Abstract only Introduction: Increased hemodynamic responses to psychological stress have been associated with adverse CAD events. African Americans (AA) have worse CAD outcomes than other groups. Heightened hemodynamic responses to stress may play a role. Our hypothesis was that AA would have higher hemodynamic reactivity to a standardized mental stress compared to Non-African Americans (NAA). Methods: We evaluated 574 patients (163 AA) with CAD, who underwent a standardized mental stress challenge. Hemodynamics were obtained at rest, during stress (speaking task), and during recovery. The rate-pressure product (RPP) was calculated as systolic blood pressure (SBP) x heart rate (HR). Hemodynamic reactivity was evaluated as the difference in RPP at rest and during stress. Depressive symptoms were measured with the Beck Depression Inventory-II (BDI). Results: As compared to NAA, AA patients were younger, had lower education and income, and higher prevalence of diabetes, obesity, hypertension, smoking, and depressive symptoms (BDI mean scores 9.8 vs. 7.6, p= 0.003). AA patients had higher blood pressure during all three periods (Table). However, hemodynamic reactivity with stress was significantly lower in AA than NAA (RPP reactivity 3114 vs 3620, p= 0.02). Adjusting for baseline RPP, age, gender and smoking did not substantially alter the association. However, after adjusting for depressive symptoms, the association was attenuated by 23% (p=0.16). BMI, diabetes and beta-blocker use had minimal additional explanatory role. In the final model, baseline RPP, depressive symptoms and BMI were significantly associated with a lower RPP reactivity (p<0.01). Conclusion: AA patients with CAD, compared with NAA, have elevated blood pressure throughout mental stress, but tend to have blunted hemodynamic reactivity to stress. Depressive symptoms, which are more elevated among AA, play a role in this different response to stress and may be implicated in the higher CAD risk of this group.