Cardiovascular Reactivity to Mental Stress and Mortality in Patients With Heart Failure

OBJECTIVES This study examined whether blood pressure (BP) and heart rate responses to acute mental stress were associated with mortality in patients with heart failure (HF). BACKGROUND HF is characterized by reduced contractility and impaired BP reactivity. Compared to exercise-induced physiological changes, the effects of mental stress on BP and heart rate in HF are not well understood. METHODS Patients with systolic HF (N = 100, 26% female, mean 65 +/- 12 years of age) underwent a structured public speech task, during which BP and heart rate were recorded. Stress-induced BP and heart rate reactivity were categorized as high (>75%), intermediate (25% to 75%), or low (<25%). Cox proportional hazards regressions were used to examine the predictive value of cardiovascular stress responses for mortality (median follow-up = 48.5 months), adjusting for age, implanted devices, and baseline BP and heart rate levels. RESULTS At follow-up, 31 patients had died (31%). Mortality rates were 2 times higher (hazard ratio [HR]: 2.04; 95% confidence interval [CI]: 1.15 to 3.60; p = 0.014) among patients with the lowest diastolic BP responses (mean = -2.4 +/- 5.4 mm Hg) to mental stress than among those patients with an intermediate diastolic BP response (mean = 7.3 +/- 2.5 mm Hg), adjusting for covariates. High diastolic BP reactivity (mean = 16.3 +/- 3.4 mm Hg) was not related to mortality (HR: 0.95; 95% CI: 0.55 to 1.66). Systolic BP responses showed a similar but nonsignificant association. Multivariate analyses showed that a high heart rate response (>6.3 beats/min) to acute mental stress was associated with a reduced mortality risk (HR: 0.40; 95% CI: 0.16 to 1.00; p = 0.051) compared to patients with intermediate responses. CONCLUSIONS Low diastolic BP reactivity to mental stress is independently associated with all-cause mortality in patients with HF. Larger studies need to replicate this finding and examine the role of psychosocial variables. (C) 2015 by the American College of Cardiology Foundation.