应激后心血管功能恢复障碍可预测血压3年升高

To assess whether variation in the rate of cardiovascular recovery following exposure to acute psychological stress predicts changes in blood pressure longitudinally, independently of blood pressure at baseline and other covariates. Design: A 3- year longitudinal study. Participants: A total of 209 men and women aged 45- 59 years at baseline, with no history of cardiovascular disease including hypertension. Method: Measurement of blood pressure, heart rate, heart rate variability, cardiac index and total peripheral resistance at rest, during two moderately stressful behavioural tasks and up to 45 min post-stress. Stress reactivity was defined as the difference in values between tasks and baseline, and post-stress recovery as the difference between recovery levels and baseline. Outcome measures: Resting blood pressure measured at baseline and 3 years later. Seven individuals had been prescribed hypertensive medication on follow-up. Results: Increases in systolic blood pressure(SBP) were predicted by impaired post-stress recovery of SBP(P< 0.001), diastolic blood pressure(DBP)(P< 0.001) and total peripheral resistance(P=0.003), independently of baseline blood pressure, age, gender, socio-economic status, hypertensive medication, body mass and smoking. The adjusted odds of an increase in SBP ≥ 5mmHg were 3.50[95% confidence interval(CI) 1.19 to 10.8] for individuals with poor compared with effective post-stress recovery of SBP. Three year increases in diastolic pressure were predicted by impaired recovery of SBP(P< 0.001) and DBP(P=0.009) pressure and by heart rate variability during tasks(P=0.002), independently of covariates. Conclusions: Impaired post-stress recovery and less consistently heightened acute stress reactivity may index disturbances in the regulation of cardiovascular stress responses that contribute to longitudinal changes in blood pressure in middle-aged men and women.

应激诱发的白介素-6和纤维蛋白原升高可预测3年随访时的动态血压变化

Background: The biological mechanisms underlying the association between psychological stress and hypertension are poorly understood. Increased plasma concentrations of the inflammatory proteins interleukin-6 and fibrinogen are commonly reported both in hypertensive patients and in people subject to chronic psychological stress. Recent laboratory studies have also shown that acute psychological stress increases plasma interleukin-6 and fibrinogen concentrations in healthy individuals. Objective: To investigate the relationship between stress-induced inflammatory responses and blood pressure using a longitudinal design. Methods: Participants were 153 individuals from the Whitehall II cohort. Blood pressure, plasma interleukin-6 and fibrinogen were assessed in response to an acute laboratory stressor, and ambulatory blood pressure was monitored on a separate day. Three years later, a follow-up day of ambulatory blood pressure monitoring was carried out. Results: Individual differences in systolic pressure, fibrinogen and interleukin-6 stress responses predicted ambulatory blood pressure at the 3-year follow-up. Larger increases in ambulatory systolic pressure over the 3-year period were predicted by larger acute fibrinogen and interleukin-6 stress responses, independently of previous ambulatory blood pressure, acute blood pressure stress responses, age, sex, body mass and smoking. Conclusion: Given the important roles of interleukin-6 and fibrinogen in hypertensive pathophysiology, these results indicate that psychological stress could promote hypertension through stimulating these inflammatory proteins.

心脏病患者的创伤后应激症:根据急性冠状动脉综合征住院期间的情绪反应预测疾病易感性

目的:在因急性冠状动脉综合征(ACS)住院3个月时,应用创伤后应激自评量表来评估创伤后应激症(PTSD)的发生率和预测因素。设计:2个阶段的前瞻性研究。机构:4个冠心病监护病房。患者:135例经ECG和心肌酶学变化而证实为ACS的住院患者。

急性冠状动脉综合征后恢复工作的心理和临床预测因素

目的：急性冠状动脉综合征（ACS）后重新开始工作是患者恢复的一项重要指征，但尚未在当前急性患者护理领域被广泛研究。方法和结果：对共126例ACS入院前从事工作的患者进行研究，观察指标包括患者的既往史、ACS类型、ACS严重程度、临床治疗以及社会人口统计学特征。入院后7—10d检测患者的抑郁情绪（Beck抑郁量表）和D型性格。其中，101例（80．2％）在12～13个月后恢复工作。未能恢复工作与入院时的心脏因素（心力衰竭、心律失常）、干预治疗数月内出现的并发症以及住院期间的抑郁分数有关，与年龄、性别、社会经济状况、ACS类型、心脏病史、急性临床治疗或D型性格无关。