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.