Cerebrovascular mental stress reactivity is impaired in hypertension

BACKGROUND Brachial artery reactivity in response to shear stress is altered in subjects with hypertension. Since endothelial dysfunction is generalized, we hypothesized that carotid artery (CA) reactivity would also be altered in hypertension. PURPOSE To compare (CA endothelium-dependent vasodilation in response to mental stress in normal and hypertensive subjects. METHODS We evaluated CA reactivity to mental stress in 10 young healthy human volunteers (aged 23 +/- 4 years), 20 older healthy volunteers (aged 49 +/- 11 years) and in 28 patients with essential hypertension (aged 51 +/- 13 years). In 10 healthy volunteers and 12 hypertensive subjects, middle cerebral artery (MCA) PW transcranial Doppler was performed before and 3 minutes after mental stress. RESULTS Mental stress by Stroop color word conflict, math or anger recall tests caused CA vasodilation in young healthy subjects (0.61 +/- 0.06 to 0.65 +/- 0.07 cm, p < 0.05) and in older healthy subjects (0.63 +/- 0.06 to 0.66 +/- 0.07 cm, p < 0.05), whereas no CA vasodilation occurred in hypertensive subjects (0.69 +/- 0.06 to 0.68 +/- 0.07 cm; p, NS). CA blood flow in response to mental stress increased in young healthy subjects (419 +/- 134 to 541 +/- 209 ml, p < 0.01 vs. baseline) and in older healthy subjects (351 +/- 114 to 454 +/- 136 ml, p < 0.01 vs. baseline) whereas no change in blood flow (444 +/- 143 vs. 458 +/- 195 ml; p, 0.59) occurred in hypertensive subjects. There was no difference in the CA response to nitroglycerin in healthy and hypertensive subjects. Mental stress caused a significant increase in baseline to peak MCA systolic (84 +/- 22 to 95 +/- 22 cm/s, p < 0.05), diastolic (42 +/- 12 to 49 +/- 14 cm/s, p < 0.05) as well as mean (30 +/- 13 to 39 +/- 13 cm/s, p < 0.05) PW Doppler velocities in normal subjects, whereas no change in systolic (70 +/- 18 to 73 +/- 22 cm/s, p < 0.05), diastolic (34 +/- 14 to 37 +/- 14 cm/s, p = ns) or mean velocities (25 +/- 9 to 26 +/- 9 cm/s, p = ns) occurred in hypertensive subjects, despite a similar increase in heart rate and blood pressure in response to mental stress in both groups. CONCLUSION Mental stress produces CA vasodilation and is accompanied by an increase in CA and MCA blood flow in healthy subjects. This mental stress induced CA vasodilation and flow reserve is attenuated in subjects with hypertension and may reflect cerebral vascular endothelial dysfunction. Assessment of mental stress induced CA reactivity by ultrasound is a novel method for assessing the impact of hypertension on cerebrovascular endothelial function and blood flow reserve.