Mental stress in HF patients leads to increase in heart rate, blood pressure

Mental stress among heart failure patients led to a significant increase in heart rate and diastolic and systolic blood pressure in a study of patients who prepared and gave a speech about their personal strengths and weaknesses. 

Lead researcher Nina Kupper, PhD, of Tilburg University in the Netherlands, and colleagues found that patients with the lowest diastolic blood pressure responses to mental stress had an increased risk of all-cause mortality. There was no increased mortality risk based on patients’ systolic blood pressure measurements.

Results were published in the May issue of the Journal of the American College of Cardiology: Heart Failure.

Kupper et al examined 100 patients with stable heart failure and reduced left ventricular ejection fraction who enrolled in an outpatient clinic between September 2006 and September 2008.

The mean age was 66.6 years old, and 74 percent of patients were males. The most common medications patients took before enrolling were ACE inhibitors or ARBs (89 percent of patients), beta-blockers (82 percent) and diuretics (61 percent).

At the start of the study, each patient was asked to sit quietly for 10 minutes, during which researchers collected baseline data. They were then told to prepare the speech for three minutes. Patients then delivered the three-minute speech to a researcher, whom patients were told would rate their performance. After the speech, patients rested for 10 minutes.

Patients had their blood pressure and heart rate measured during the rest periods, the preparation and the speech.

The researchers said their findings were similar to an earlier study of patients with acute coronary syndrome that found low blood pressure and heart rate in response to mental stress were associated with a doubling in risk for future clinical events.

They mentioned that the small sample size in this study may have been a limitation and was a reason they examined all-cause mortality but not cardiovascular mortality. They also wrote that only a small number of patients had devices implanted because the procedures were not common during the time period studied.