Psychological stress and diastolic blood pressure: interaction with coronary artery disease (a multicenter cohort study)

Background Psychological stress is a recognized cardiovascular risk factor, but its precise impact on blood pressure (BP) and heart rate (HR) remains to be fully elucidated. Furthermore, it is unclear whether this impact depends on the patient's overall clinical status and baseline cardiovascular health. This study aims to investigate the association of stress and cardiovascular parameters, evaluating if the presence of coronary artery disease (CAD) modulates this relationship. Methods In this multicenter cross-sectional study, 675 consecutive cardiac outpatients were. Psychological stress was evaluated with a physician-administered psycho-emotional questionnaire. Participants were stratified into three groups based on the presence of symptoms: (1) No Stress, for patients with no history of stress-related symptoms; (2) Present Stress, for patients reporting active symptoms within the last 3 months; and (3) Previous Stress, for patients whose symptoms had been absent for at least 3 months, indicating a non-active stress status at the time of evaluation. Resting systolic (SBP), diastolic (DBP) blood pressure, HR were evaluated twice, 5 minutes apart, and compared between groups. Data were analyzed using multiple linear regression models. Starting from a full model adjusting for key confounders (age, sex, BMI, smoke, coffee, alcohol, physical activity, diabetes, CAD, therapy of beta – blockers, calcium channel blockers, anxiolytics), a parsimonious model was derived to identify the most significant independent predictors of BP. Interaction terms were tested to evaluate the moderating effects of clinical variables. Analyses were carried out using STAT 18.0 StataCorp LLC, (TX) USA. Results Mean age±SD was 65.1 ± 15.0 years; 301 (45%) were female, 110 (17%) were CAD. No stress was reported by 302 (45%) patients, Present stress by 264 (39%), Previous Stress by 109 (16)%. Mean BP±SD was 147±22/82±11 mmHg and mean HR±SD was 71±14 bpm. At univariable and fully adjusted model, CAD was associated with lower DBP (β±SE=-2.6±1.1, p=0.02) and lower HR (β±SE=-5.8±1.5, p<0.0001), Present stress was found to be associated with higher DBP (β=3.0±0.9, p=0.001) while Previous Stress was not found to be associated with BP nor HR. When a formal interaction between stress and CAD was set, CAD was found to increase the impact of Present stress on DBP (interaction β±SE=5.9±2.3, p=0.01) while it did not modify the impact of Previous stress. No significant interactions were found for SBP or HR Conclusions In this cohort, Present stress was independently associated with higher DBP, particularly in patients with CAD, whereas Previous stress showed no association with cardiovascular parameters. These findings indicate that the cardiovascular effects of stress may differ according to baseline cardiovascular health, supporting the need for stress assessment within individualized cardiovascular risk stratification frameworks.