Individual Differences in Cardiovascular Response to Stress

Individual Differences in Cardiovascular Response to Stress

PERSPECTIVES ON INDIVIDUAL DIFFERENCES CECIL R. REYNOLDS, Texas A&M Uni1Je1'8ity, CoUege Station ROBERT T. BROWN, University of Nurth Carolina, Wilmi1/{/ton Current volumes in the series DEMENTIA Allen Jack Edwards EXPLORATIONS IN TEMPERAMENT International Perspectives on Theory and Measurement Edited by Jan Strelau and Aloia Angleitner HANDBOOK OF CREATIVITY Assessment, Research, and Theory Edited by John A Glover, Royce R. Ronning, and Cecil R. Reynolds HANDBOOK OF MULTIVARIATE EXPERIMENTAL PSYCHOLOGY Second Edition Edited by John R. Nesselroade and Raymond B. Cattell INDMDUAL DIFFERENCES IN CARDIOVASCULAR RESPONSE TO STRESS Edited by J. Rick Turner, Andrew Sherwood, and Kathleen C. Light THE INDMDUAL SUBJECT AND SCIENTIFIC PSYCHOLOGY Edited by Jaan Valsiner LEARNING STRATEGIES AND LEARNING STYLES Edited by Ronald R. Schmeck METHODOLOGICAL AND STATISTICAL ADVANCES IN THE STUDY OF INDMDUAL DIFFERENCES Edited by Cecil R. Reynolds and Victor L. Willson PERSONALITY, SOCIAL SKILLS, AND PSYCHOPATHOLOGY An Individual Differences Approach Edited by David G. Gilbert and James J. Connolly SCHIZOPHRENIC DISORDERS Sense and Nonsense in Conceptualization, Assessment, and Treatment Leighton C. Whitaker A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.

Individual Differences in Cardiovascular Response to Stress Edited by J. Rick Turner Andrew Sherwood and Kathleen C. Light University of Norllt Carolina at Chapel HiU Chapel HiU, Nurth Carolina Springer Science+Business Media, LLC

Library of Congress Catalog1ng-tn-Publteat ton Data Individual differences in cardiovascular response to stress / edited by J. Rick Turner, Andrew Sherwood, and Kathleen C. Light. p. cm. (Perspectives on individual differences) Includes bibliographical references and index. 1. Cardiovascular system Pathophysiology. 2. Stress (Physiology) 3. Stress (Psychology) I. Turner, J. Rick. II. Sherwood, Andrew. III. Light, Kathleen C. IV. Series. [DNLM: 1. Cardiovascular System physlopatholdgy. 2. Individuality. 3. Stress, Psychological physiopathology. WG 100 139] RC669.9.I53 1992 616.1* 08 dc20 DNLM/DLC for Library of Congress 92-49958 CIP ISBN 978-1-4899-0699-1 DOI 10.1007/978-1-4899-0697-7 ISBN 978-1-4899-0697-7 (ebook) Springer Science+Business Media New York 1992 Originally published by Plenum Press, New York in 1992 Softcover reprint of the hardcover 1st edition 1992 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, niim)ntming, recording, or otherwise, without written permission from the Publisher

To the Memory of Paul A Obrist

Contributors Bruce S. Alpert, Department of Pediatrics, University of Tennessee, Memphis, Tennessee 38103 Norman B. Anderson, Departments of Psychiatry and Psychology, Social and Health Sciences, Duke University, Durham, North Carolina 27710 James A. Blumenthal, Departments of Psychiatry and Psychology, Duke University Medical Center, Durham, North Carolina 27710 Ronald Bulbulian, Department of Health, Physical Education, and Recreation, University of Kentucky College of Education, Lexington, Kentucky 40536-0219 Robyn Cheung, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0086 Joel E. Dimsdale, Department of Psychiatry, University of California at San Diego, La Jolla, California 92093 Roger B. Fillingim, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710 Gregory A. Harshfield, Department of Pediatrics, University of Tennessee, Memphis, Tennessee 38103 B. Kent Houston, Department of Psychology, University of Kansas, Lawrence, Kansas 66045-2160 vii

viii CONTRIBUTORS Kathleen C. Light, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7175 William R. Lovallo, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, and Veterans Affairs Medical Center, Oklahoma City, Oklahoma 73190 James A. McCubbin, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0086 Maya McNeilly, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710 Paul J. Mills, Department of Psychiatry, University of California at San Diego, La Jolla, California 92093 Thomas B. Montgomery, Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0086 Hector Myers, Department of Psychology, University of California at Los Angeles, and Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California 90024 Derrick A. Pulliam, Department of Pediatrics, University of Tennessee, Memphis, Tennessee 38103 RichardJ. Rose, Department of Psychology, Indiana University, Bloomington, Indiana 47405 Andrew Sherwood, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7175 Catherine M. Stoney, The Miriam Hospital and Brown University School of Medicine, Division of Behavioral Medicine, Providence, Rhode Island 02906 J. Rick Turner, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7175; present address: School of Public Health, University of California at Berkeley, Berkeley, California 94720 Lorenz J. P. van Doomen, Division of Psychophysiology, Free University of Amsterdam, Amsterdam, The Netherlands 1081 HV

CONTRIBUTORS ix Dawn K. Wilson, Department of Pediatrics, University of Tennessee, Memphis, Tennessee 38103 John F. Wilson, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0086 Michael F. Wilson, Department of Medicine, University of Oklahoma Health Sciences Center, and Veterans Affairs Medical Center, Oklahoma City, Oklahoma 73190

Preface The study of cardiovascular responses to psychosocial stress is one of the major avenues of investigation in the rapidly growing field of cardiovascular behavioral medicine. It has become apparent that the magnitudes, and indeed patterns, of cardiovascular responses to stress exhibit marked variation among individuals. Although all individual difference phenomena are of intrinsic interest to experimental behavioral scientists, this particular individual variation dimension has attracted additional scrutiny because of hypothesized links between large-magnitude stress responses and the later development of cardiovascular disease. In recent years, it is this possibility that has motivated a large proportion of the numerous investigations conducted to delineate various characteristics of stress responses, such as their stability across time and situation, their genetic and environmental determinants, and their association with other hypothesized influences on cardiovascular pathophysiology. The invitation to prepare this volume, afforded to the authors by series editor Robert T. Brown, came at an opportune time in the development of this research field. Following seminal research by Paul Obrist and his contemporaries in the 19708 and 1980s, the rigorous execution of many experiments has demonstrated the reproducibility of individual differences in stress responses. Now, the next generation of scientists is in the enviable position of being able to start to test some of the hypotheses linking behaviorally elicited cardiovascular excitation with cardiovascular morbidity. This book aims to present a sample of this research to interested behavioral scientists from a variety of disciplines. The following chapters, then, describe the relationship among stress, cardiovascular response, and potential disease outcomes. The book is divided into three parts. The first provides an introduction to the assessment of both inlaboratory and ambulatory (those occurring during people's naturalistic daily activities) stress responses. Both conceptual and methodological issues are introduced, and the mechanisms by which the cardiovascular system is mobilized during psychological stress are discussed. The second part examines the xi

xii PREFACE detenninants of individual differences in stress responses. Contained within this section are investigations of the influence of genetic inheritance, environment, personality, race, gender, and age. The potentially moderating influence of aerobic exercise and associated clinical implications are also discussed. Finally, the third part focuses on the psychophysiological processes by which responses to stress may be translated over time into cardiovascular disease. The roles of endogenous opioids and salt are examined, and a biobehavioral model of hypertension development is presented. The final chapter of the volume evaluates present evidence concerning the degree to which present-day stress responses predict future cardiovascular pathology; if they do so well, intervention and thus preventive medicine may be viable. A major goal of the volume is to emphasize the interdependence and mutual elucidation of all topics discussed A complete understanding of biobehavioral interactions, and any possible pathogenic consequences, requires that all useful avenues of inquiry and investigative techniques are combined appropriately in integrative research strategies. Contained within the volume's chapters are, for example, discussions of recent advances in the conceptualization of relevant issues, the measurement techniques of cardiovascular psychophysiology, the experimental paradigms of behavioral medicine (such as interpersonal stressors and tasks suitable for large-scale studies of heterogeneous subject samples), and the analytical techniques of behavioral genetics. Research approaches combining several of these advances, among others, seem crucial in an area in which associations and interactions among different influences are so important. In this way, although we do not yet have all the answers, perhaps we may be able to start asking the right questions. We express sincere thanks to chapter authors for their promptness and their willingness to comply with editorial requests; to series editor Robert Brown and to Eliot Werner at Plenum for advice throughout the project; and to Dot Faulkner for secretarial assistance. Chapel Hill, Narth Carolina J. Rick Turner Andrew Sherwood Kathleen C. Light

Contents Part One. CARDIOVASCULAR REACTIVITY: LABORATORY AND AMBULATORY ASSESSMENT PROCEDURES Chapter One. A Conceptual and Methodological Overview of Cardiovascular Reactivity Research.......................... 3 Andrew Sherwood and J. Rick Turner Introduction................................................ 3 The Biological Perspective... 4 Assessment of Reactivity..................................... 7 Individual Differences... 10 Psychosomatic Aspects of Cardiovascular Reactivity............. 14 Temporal Stability........................................... 17 Situational Stability.......................................... 19 Summary and Future Directions.............................. 25 References................................................. 27 Chapter Two. Sympathetic Nervous System Responses to Psychosocial Stressors...................................... 33 Paul J. Mills and Joel E. Dimsdale Introduction................................................ 33 Considerations of Catecholamine Physiology.................... 33 Individual Variability in Catecholamine Responses to Stressors... 34 New Frontiers.............................................. 38 Summary............ 44 References................................................. 45 xiii

xiv CONTENTS Chapter Three. Individual Differences in Ambulatory Blood Pressure Patterns.......................................... 51 Gregory A HarshjWld and Derrick A PuUiam Introduction................................................ 51 What Is a ''Typical'' ABP Pattern?....................... 51 Factors Associated with Individual Differences in ABP Patterns.................................................. 52 Summary and Conclusions.................................... 58 References................................................. 58 Chapter Four. The Ecological Validity of Laboratory Stress Testing... 63 Lorenz J. P. van Doornen and J. Rick Turner Introduction................................................ 63 Lab Reactivity and Self-Monitored Casual Blood Pressure... 65 Lab Reactivity and Average Ambulatory Levels................. 66 Studies Predicting Both Real-Life Variability and/or Average Levels... 68 Studies Measuring Ambulatory Blood Pressure Invasively on a Beat-by-Beat Basis........................................ 73 Studies Predicting the Response to a Well-Defined Real-Life Stressor.................................................. 75 Discussion.................................................. 77 References................................................. 81 Part Two. DETERMINANTS OF INDIVIDUAL DIFFERENCES IN CARDIOVASCULAR RESPONSES DURING STRESS Chapter Five. Genes, Stress, and Cardiovascular Reactivity........ 87 Richard J. Rose Introduction................................................ 87 Differential Reactivity: G x E Interaction...................... 89 Selective Transaction: G x E Correlation...................... 95 Summary................................................... 100 References... 100

CONTENTS xv Chapter Six. Personality Characteristics, Reactivity, and Cardiovascular Disease..................................... 103 B. Kent Houston Introduction... 103 Personality Characteristics Affecting the Appraisal Process... 106 Personality Characteristics Influencing Emotional Arousal... 107 Personality Characteristics Influencing Motivational Arousal... 111 Characteristics Modulating Emotional and Motivational Arousal... 113 MultifacetedConstructs... 114 Issues in Conducting Research on Personality and Reactivity..... 117 References................................................. 118 Chapter Seven. Toward Understanding Race Difference in Autonomic Reactivity: A Proposed Contextual Model......... 125 Norman B. Aru.imson, Maya McNeilly, and Hector Myers Introduction................................................ 125 Black-White Differences in Reactivity... 126 Predictors of Reactivity among Blacks......................... 128 Summary of Research Findings............................... 130 Augmented Reactivity in Blacks: A Contextual Model............ 130 Testing the Contextual Model: Directions for Research.......... 139 Summary and Conclusions... 139 References... 140 Chapter Eight. The Role of Reproductive Hormones in Cardiovascular and Neuroendocrine Function during Behavioral Stress... 147 Catherine M. Stoney Introduction................................................ 147 Sex Differences in Adult Stress Responses..................... 148 Investigations of Individuals through Their Reproductive Lives... 150 Investigations of Individuals Receiving Exogenous Hormones..... 157

xvi CONTENTS Conclusions... 160 References................................................. 160 Chapter Nine. The Role of Cardiovascular Reactivity in Hypertension Risk... 165 WiUiam R. Lovallo and Michael F. Wilson Introduction...... 165 Background Issues.......................................... 165 Tasks and Response Types in Studies of Reactivity... 166 Rationale for Behavioral Studies of Reactivity in High-Risk Normotensives............................................ 169 Parental History of Hypertension... 169 Cardiovascular Function in PH + and PH - Persons............. 170 Borderline Hypertension..................................... 174 Longitudinal Studies of Borderline Hypertensives and Other High-Risk Groups......................................... 177 Summary... 180 References................................................. 181 Chapter Ten. Stress Reactivity in Childhood and Adolescence...... 187 Bruce S. Alpert and Dawn K Wilson Introduction................................................ 187 Individual Differences in Genetic Background................... 189 Environmental Factors and Reactivity... 193 Personality Factors and Reactivity... 196 Conclusions................................................. 198 References................................................. 198 Chapter Eleven. Does Aerobic Exercise Reduce Stress Responses?.. 203 Roger B. FiUingim and James A. Blumenthal Introduction and Objectives... 203 Methodological Issues........................................ 204 Cross-Sectional Studies of Physical Fitness and Cardiovascular Reactivity................................................ 208

CONTENTS xvti Longitudinal Studies of Physical Fitness and Cardiovascular Reactivity................................................ 210 Effects of Acute Aerobic Exercise on Cardiovascular Reactivity................................................ 212 Concluding Comments and Future Directions................... 213 References... 214 Part Three. CARDIOVASCULAR STRESS RESPONSES AND CARDIOVASCULAR DISEASE Chapter Twelve. Endogenous Opioids and Stress Reactivity in the Development of Essential Hypertension...................... 221 James A McCubbin, Robyn Cheung, Thomas B. Montgomery, Ronald Bulbulian, and John F. Wilson Introduction................................................ 221 Stress Reactivity and the Developmental Etiology of Essential Hypertension............................................. 222 Stress Reactivity and the Endogenous Opioid Neuropeptides... 224 Experimental Studies of Individual Differences in Inhibitory Opioid Tone.............................................. 225 Discussion.................................................. 238 References................................................. 240 Chapter Thirteen. Differential Responses to Salt Intake-Stress Interactions: Relevance to Hypertension..................... 245 Kathleen C. Light Introduction................................................ 245 The Influence of Sodium Excretion and Retention on Blood Pressure................................................. 246 Stress Exposure Alters Sodium Excretion in Animal Models...... 248 Stress Exposure Alters Sodium Excretion in Man............... 250 Cardiovascular Responses on High- versus Low-Salt Diets....... 255 Summary................................................... 259 References................................................. 261

xviii CONTENTS Chapter Fourteen. A Biobehavioral Model of Hypertension Development............................................... 265 WiUiam R. Lovallo and Michael F. Wilson A Model of Hypertension Development........................ 265 Heritability of Resting Blood Pressure and Cardiovascular Reactivity in Humans...................................... 274 Relationship between Cardiovascular Reactivity and Hypertension Risk... 275 Implications................................................ 277 References................................................. 278 Chapter Fifteen. High Cardiovascular Reactivity to Stress: A Predictor of Later Hypertension Development.............. 281 Kathleen C. Light, Andrew Sherwood, and J. Rick Turner Introduction................................................ 281 High Pressor Response to the Cold Pressor Test Enhances Risk of Hypertension...................................... 282 High Diastolic Pressure Reactivity to Mental Arithmetic Predicts Early Hypertension....................... 283 High Heart Rate and Blood Pressure Reactivity as Predictors of Resting and Ambulatory Blood Pressure on Follow-Up... 286 Integration of Findings to Date and Recommendations for Future Prospective Studies........................................ 287 References................................................. 292 Index... 295