Psychological Stress Alteration and Cv Modification in Cardiovascular Disease Outpatients. The Abc Study on Heart Disease

Abstract Introduction Psychological stress is one of the most common patient complaints. Its influence on the physiology of the cardiovascular system, and on the aetiology and outcomes of cardiovascular disease (CVD) has been the object of intense investigation. In fact, current knowledge points to a “brain–heart axis” that is especially important in individuals with pre–existing CVD. Aim Evaluation of psychological stress reactivity and its cardiovascular effects in CVD outpatients. Methods Patients presented to the outpatient cardiology clinic of Conegliano General Hospital in the last 5 years were divided into 2 groups according to the presence or absence of stress symptoms based on the patient’s self–assessment psycho–emotion questionnaire. Results 415 patients were included in this preliminary analysis. Patients‘ mean age was 66±18 years and 57% were males. Coronary artery diseases were registered in 93(22%) patients and 231 (56%) patients reported stress symptoms. They shared most demographic and clinical characteristics with patients who did not report stress symptoms. However, males were more frequent among patients with no stress. Interestingly, we observed no difference in systolic blood pressure values (SBP) between both groups, (148±21 Vs 145±23 mmHg, p= 0.15) for symptomatic and non–symptomatic patients respectively. Although, symptomatic patients had significantly higher values of diastolic blood pressure (DBP) than non–non–symptomatic patients, (81±10 Vs 77±11 mmHg respectively, p0.02). Using multivariable linear regression models, age was an independent predictor for higher SBP values (β±SE= 0.5±0.1, p0.0001), yet male gender and psychological stress were independent predictors for higher DBP values (β±SE were (2.9±1.1, p=0.007) and (4.3±1.1, p0.0001) respectively). Results Kept true even with repeated BP measurements, Figure 1. Subgroup analysis revealed the same results among non–CAD patients. Yet, for CAD patients stress was not an independent predictor for higher BP values, full–adjusted β±SE were (1.9±5.0, p=0.69) and (3.7±22.3, p=0.10) for SBP and DBP, respectively. Conclusion Psychological stress alterations are associated with a significant increase in DBP values, chiefly in non–CAD–outpatients.