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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:2547.)
© 2006 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Delayed Blood Pressure Recovery After Psychological Stress Is Associated With Carotid Intima-Media Thickness

Whitehall Psychobiology Study

Andrew Steptoe; Ann E. Donald; Katie O’Donnell; Michael Marmot; John E. Deanfield

From the Department of Epidemiology and Public Health (A.S., K.O., M.M.), and the Vascular Physiology Unit (A.E.D., J.E.D.) Institute of Child Health, UCL, London.

Correspondence to Andrew Steptoe, Department of Epidemiology and Public Health, 1-19 Torrington Place, University College London, London WC1E 6BT, UK. E-mail a.steptoe{at}ucl.ac.uk

Objective— Delayed blood pressure (BP) recovery after psychological stress is associated with low socioeconomic status (SES) and prospectively with increases in clinic BP. We tested whether poststress BP recovery was related to carotid atherosclerosis.

Methods and Results— Psychophysiological stress testing was performed with a healthy subgroup of the Whitehall II epidemiological cohort, and recovery systolic BP was monitored 40 to 45 minutes after stressful behavioral tasks. Carotid ultrasound scanning was conducted on 136 men and women (aged 55.3±2.7 years) 3 years after stress testing. Participants were divided into those whose systolic BP had returned to baseline in the recovery period (adequate recovery, n=37), and those whose BP remained elevated (delayed recovery, n=99). Systolic BP stress responses did not differ in the 2 groups. Carotid intima-media thickness (IMT) was associated with delayed recovery in lower SES (means 0.78 versus 0.65 mm) but not higher SES participants (means 0.75 versus 0.74 mm) after adjustment for age, gender, baseline systolic BP, and resting BP, smoking, body mass and fasting cholesterol at the time of ultrasound scanning (P=0.010).

Conclusions— Variations in poststress recovery reflect dysfunction of biological regulatory processes, and may partly mediate psychosocial influences on cardiovascular disease.

Delayed blood pressure recovery after psychological stress was associated with carotid intima-media thickness (IMT) in men and women of low but not high socioeconomic status independently of conventional risk factors. Variations in poststress recovery reflect dysfunction of biological regulatory processes, and may partly mediate psychosocial influences on cardiovascular disease.

Key Words: atherosclerosis • blood pressure • recovery • socioeconomic status • stress