Emotional coping and tonic blood pressure as determinants of cardiovascular reactions to mental stress

OBJECTIVES: The aim was to assess the combined influence of biological risk for hypertension and patterns of emotional control upon cardiovascular responses to mental stress tests. DESIGN: The study involved the administration of mental stress tests in the laboratory, designed to elicit substantial blood pressure and heart rate responses accompanied by suppression of cardiac baroreflex sensitivity. METHODS: Thirty-seven young men were selected as being at relatively high or low risk through having high or low normal blood pressure. Blood pressure, recorded continuously using the Finapres, heart rate, cardiac baroreflex sensitivity, skin conductance and respiration rate were monitored at rest and during mental arithmetic and mirror drawing tasks. RESULTS: Hypertension risk category had no overall effect upon cardiovascular reactions to mental stress. Two dimensions of emotional coping were identified through factor analysis of psychological questionnaires--anxious emotional inhibition (ratings of trait anxiety, anger in and self-concealment), and anger experience and expression (ratings of trait anger and anger out). Subjects with high and low scores on these dimensions were equally represented in the two blood pressure risk categories. Hypertensive risk interacted with anxious emotional inhibition, with the greatest systolic blood pressure and heart rate responses (accompanied by cardiac baroreflex inhibition) being recorded in subjects at high risk coupled with high anxious emotional inhibition. Anger experience and expression did not interact with hypertension risk, but had a direct effect upon cardiovascular responses to mental stress. No differences were seen in skin conductance or respiratory responses, suggesting specific disturbances of cardiovascular regulation. CONCLUSIONS: The results suggest that normotensives at risk for future hypertension are likely to show heightened stress-related cardiovascular responses if they also tend to inhibit the expression of negative emotions. This pattern may be relevant to the postulated links between hypertension and emotional inhibition