Shari R. Waldstein

Hypertension and neuropsychological performance in men: interactive effects of age.

Potentially interactive effects of hypertension and age on the performance of neuropsychological and information processing tests were examined in 123 untreated hypertensive and 50 normotensive men. After covarying education, average alcohol consumption, trait anxiety, and depression scores, results indicated an interaction of age and hypertension. Young hypertensive men (23-40 years) scored significantly worse than young normotensive men on tests of attention/executive function and working memory; middle-aged hypertensive (41-56 years) and normotensive participants were not distinguished by any measures. Hypertensive men performed significantly more poorly than normotensive men on tests of manual dexterity. Results suggest that neuropsychological sequelae of hypertension are more pronounced in young than in middle-aged hypertensive individuals and are independent of various demographic, psychosocial, and alcohol-related factors.

ACTIVE COPING AND CARDIOVASCULAR REACTIVITY : A MULTIPLICITY OF INFLUENCES

Objective Active coping enhances cardiovascular response presumably by beta-adrenergically mediated myocardial activation. This study examined impedance-derived hemodynamic parameters underlying blood pressure response to two laboratory tasks requiring active coping, performed either with or without an appetitive (ie, monetary) incentive. Method Forty-eight healthy, young men completed the Stroop Color-Word Test and Mirror Tracing. Half received no incentive, whereas half were provided with a monetary incentive as an active coping manipulation. Task-related changes in blood pressure, heart rate, systolic time intervals, and hemodynamic parameters were monitored. Psychological responses to the tasks were also obtained. Results On average, incentive virtually doubled blood pressure response to both Stroop and Mirror Tracing. The change in blood pressure was explained predominantly by a concomitant increase in total peripheral resistance. Heart rate response was also enhanced substantially with incentive. Individuals in the incentive condition reported greater interest in the task, but less perceived control, than persons in the no-incentive condition. Conclusions The incentive-related increase in total peripheral resistance, combined with an absence of enhanced stroke volume, cardiac output, or preejection period response, indicates that active coping may, under certain conditions, elevate blood pressure via increased systemic resistance, presumably reflecting alpha-adrenergic activation. Furthermore, the enhanced heart rate associated with incentive may reflect a withdrawal of parasympathetic influence.

Autonomic nervous system reactivity to positive and negative mood induction: The role of acute psychological responses and frontal electrocortical activity

The differential effects of positive versus negative emotions on autonomic nervous system activity are insufficiently understood. This study examined the role of acute mood responses and central nervous system activity on heart rate variability (HRV) using 5-min event recall tasks (happiness and anger recall) and a 5-min Stroop Color Word Test (SCWT) in 20 healthy individuals (mean age 25 ± 4 years, 55% female). HRV was measured in high frequency (HF) and low frequency (LF) domains, and frontal brain activity using electroencephalography (EEG) in the alpha frequency band in F3 and F4. Happiness Recall resulted in increased LF-HRV (p = 0.005) but not HF-HRV (p=0.71). Anger Recall did not change HRV (p-values > 0.10). The SCWT produced decreases in HF-HRV (p = 0.001) as well as LF-HRV (p = 0.001). The magnitude of feeling happy during Happiness Recall was positively correlated with ΔHF-HRV (p = 0.050), whereas an incongruent mood state (frustrated) was associated with smaller ΔHF-HRV (p = 0.070). Associations between frontal EEG activation and HRV responses were mostly non-significant, except for increased right frontal activation during Happiness Recall which was associated with a decrease in LF/HF ratio (p = 0.009). It is concluded that positive and negative mood induction result in differential HRV responses, which is related to both task valence and the intensity of task-induced emotions.

Cardiovascular reactivity and central adiposity in older African Americans.

This study examined central adiposity, as measured by waist circumference (WC), in relation to mental-stress induced systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) responses, body composition, the metabolic syndrome, and health practices in 22 older, African American men and women (ages 52-79 years). The high WC (> 100 cm) group showed significantly greater SBP, DBP, and HR reactivity, greater fasting insulin levels, lower high density lipoprotein cholesterol levels, greater fat mass in both truncal and peripheral regions, and greater body mass index as compared to the low WC (< 100 cm) group. Groups were comparable with respect to fat-free mass, peak oxygen consumption (VO2), leisure time activity, dietary intake, resting blood pressure, and other metabolic variables. The findings support a clustering of metabolic and mental stress risk factors that may predispose older African Americans to increased cardiovascular and metabolic disease.

Body mass index is positively associated with bone mineral density in US older adults

SummaryLiterature has been conflicting as to whether obesity is protective against osteoporosis. Understanding the relationship is particularly important in light of the increasing prevalence of obesity among older adults. Study results confirm a protective association between obesity and osteoporosis in a recent, nationally representative sample of US older adults.PurposeCurrently, the majority of US older adults are either overweight or obese. Evidence regarding the relationship between body composition measures and bone mass is conflicting, possibly because different measures of obesity reflect multiple mechanisms. Additionally, there are important age, gender, and racial differences in a risk of osteoporosis and fat mass composition. The objective of this study was to examine the association between body mass index (BMI) and bone mineral density (BMD) in a recent, nationally representative sample of US older adults as well as to see if this relationship differs by age, sex, and race.MethodsData for this study were obtained from the National Health and Nutrition Examination Survey (2005–2008) for adults ages 50 and older (nu2009=u20093,296). Linear regression models were used to predict BMD of the femoral neck (measured by dual-energy X-ray absorptiometry (DXA)) as a function of BMI (measured height and weight) and a range of study covariates.ResultsEvery unit increase in BMI was associated with an increase of 0.0082xa0g/cm2 in BMD (pu2009<u20090.001). Interaction terms for BMI and age (pu2009=u20090.345), BMI and sex (pu2009=u20090.413), and BMI and race (pu2009=u20090.725) were not statistically significant.ConclusionsStudy results confirm the positive association between BMI and BMD, and this relationship does not differ by age, sex, or race. A 10-unit increase in BMI (e.g., from normal BMI to obese) would result in moving an individual from an osteoporotic BMD level to a normal BMD level. Results demonstrate a protective, cross-sectional association between obesity and osteoporosis in a recent sample of US older adults.

Absence of Enhanced Sympathoadrenal Activity and Behaviorally Evoked Cardiovascular Reactivity among Offspring of Hypertensives

To determine whether offspring of hypertensives show enhanced sympathetic nervous system activity, we evaluated several indices of sympathoadrenal activation and cardiovascular responsiveness to behavioral stimuli among 90 normotensive, young adult men having either one or two hypertensive parents (PH+(-), PH++) or normotensive parents only (PH--) (n = 30/group). Measurements included heart rate (HR) and blood pressure (BP) reactions to three mental stressors (the Stroop test, mental arithmetic, mirror tracing), a cold pressor test, postural adjustment (60 degrees upright tilt), isometric exercise and bicycle ergometry, as well as the 24-h excretion of catecholamines (epinephrine [E], norepinephrine [NE]) and venous plasma catecholamine concentrations, both at rest (seated and supine) and in response to the Stroop test and upright tilt. The three groups did not differ in age, education, body mass index (BMI), estimated aerobic fitness, resting HR, cardiac preejection period (PEP) and PEP:LVET (left ventricular ejection time) ratio, 24-h Na or K excretion, or fasting lipids, insulin or plasma renin activity. Resting systolic and diastolic BP varied as a function of parental hypertension, and were significantly higher in PH++ than among PH-- subjects (P < .05). No significant group difference was observed on any measure of plasma or urinary catecholamines, nor did offspring of hypertensives (PH++ or PH+-) showed greater HR or BP reactions than PH-- subjects to any of the several laboratory challenges. In sum, we find no evidence of enhanced sympathetic activity or heightened cardiovascular responsiveness among normotensive young adults who are familially predisposed to essential hypertension.

Relationship of cardiovascular reactivity and anger expression to serum lipid concentrations in healthy young men.

The relationship between behaviorally evoked cardiovascular reactivity, preferred mode of anger expression, and serum lipid concentrations was examined in 63 healthy, young adult males. Subjects derived from three studies, each evaluating cardiovascular response to laboratory stressors. All participants completed the Spielberger Anger Expression Scale and provided fasting blood samples for lipid determinations. A significant negative correlation, calculated by meta-analytic procedures, was noted between a baseline-free measure of heart rate reactivity and high density lipoprotein-cholesterol (HDL-C) concentrations (r = -0.26, p = 0.05). However, the previously reported relationship between cardiovascular reactivity and elevated total serum cholesterol (TSC) was not found. Additionally, men scoring high on a self-report measure of the tendency to express anger outwardly had significantly higher HDL-C concentrations than men scoring low on this measure (r = 0.30, p = 0.02); when subjects were stratified by level of cardiovascular reactivity, this relationship was apparent only among those showing the greatest magnitude of heart rate and blood pressure responses to acute mental stress.

Neuropsychological performance of young men who vary in familial risk for hypertension.

&NA; Neuropsychological performance was examined as a function of parental history of hypertension. Thirty‐five normotensive offspring of two hypertensive parents (PH+/+) were compared to 35 offspring of two normotensive parents (PH‐/‐) and 35 offspring of one hypertensive and one normotensive parent (PH+/‐) on tests of abstract reasoning, attention/mental flexibility, memory, perception, psychomotor skills, and visuospatial/constructional abilities. Results indicated that PH+/+ offspring performed more poorly than PH‐/‐ offspring on tests of visuospatial/constructional and visuoperceptual ability; PH+/‐ offspring tended to score lower than PH‐/‐ offspring on these tests. These findings were independent of age, education, diastolic blood pressure levels, average alcohol consumption, trait anxiety, and depression. Results of this study may indicate subtle central nervous system involvement associated with familial risk for hypertension.

The Circular Mood Scale: A new technique of measuring ambulatory mood

This article presents a new method of assessing and quantifying qualitatively different mood states, the Circular Mood Scale. The method is suitable for self-monitoring of mood. It involves two parallel assessments, each based on one of two models of mood: the circumplex model and the prototypical model. In the main assessment, subjects record their mood states on a circular visual analogue scale, which can be scored for both quality and intensity of mood. The recordings on this circular scale are supplemented by an additional assessment in which subjects monitor a limited number of mood prototypes. We tested the Circular Mood Scale on four classes of mood stimuli: verbal mood descriptors, music, pictures of facial affects, and the subjects own mood during hourly monitoring of mood for 2 days. We determined the stability and interrater reliability of the mood ratings, as well as construct and concurrent validity. The results indicated that the Circular Mood Scale has acceptable reliability and validity. Possible applications and limitations of the instrument are discussed.

Cardiovascular Disease and Neurocognitive Function

Cardiovascular (CV) diseases confer substantial increase in risk for ischemic and hemorrhagic stroke. Yet, outside the context of clinical stroke, the brain is an under-recognized target organ of a spectrum of CV diseases. Although it has long been known that CV risk factors and diseases contribute to the development of vascular dementia, we now know that similar risk is conferred for Alzheimer’s disease. Importantly, long before clinical manifestations of stroke or dementia are apparent, CV risk factors and diseases negatively impact the brain and neurocognitive function. We suggest that there is a continuum of neurocognitive and neurobiological impairment associated with increasingly severe manifestations of CV disease across the life span. Here we provide a broad overview of current knowledge pertaining to the relation of CV risk factors and diseases to dementia, neurocognitive function, and the brain.