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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Cardiovascular reactivity and development of preclinical and clinical disease states.
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Cardiovascular reactivity and development of preclinical and clinical disease states.

机译：心血管反应性以及临床前和临床疾病状态的发展。

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OBJECTIVE: The objective of this review is to evaluate the evidence for the hypothesis that cardiovascular reactivity can predict the development of preclinical (elevated blood pressure, ventricular remodeling, carotid atherosclerosis) and/or clinical cardiovascular disease states. METHODS: A review of the literature was conducted examining prospective studies. RESULTS: Three large epidemiological studies with long-term follow-up periods (20 years or more) have found blood pressure responses to the cold pressor task to be predictive of subsequent essential hypertension in initially normotensive samples. Studies showing less consistent results have tended to use shorter-term follow-up periods. A larger body of literature demonstrates consistent associations between stress-related cardiovascular reactivity and blood pressure elevations in youth over the course of 1 to 6 years; such relationships have not been consistently shown among adult samples. Moderately consistent evidence points to a positive relationship between reactivity and other measures of subclinical disease (increased left ventricular mass and carotid atherosclerosis) among the few prospective studies that have examined these issues to date. A number of additional factors, however, such as baseline levels of disease risk and exposure to psychosocial stress, seem to moderate these relationships. Health status at baseline also seems to moderate the association between reactivity and clinical coronary heart disease in recent reports: two of three existing studies in initially healthy samples show no evidence of a relationship between reactivity and clinical outcomes, whereas three of four studies in samples with preexisting coronary heart disease or essential hypertension show a positive relationship between reactivity and subsequent disease states. CONCLUSIONS: There is reasonable evidence to suggest that cardiovascular reactivity can predict the development of some preclinical states (eg, increased left ventricular mass and blood pressure) states and perhaps even new clinical events in some patients with essential hypertension or coronary heart disease. However, much more information is needed concerning moderating and potentially confounding variables before the robustness of the positive relationships can become clinically useful.
机译：目的：本评价的目的是评估以下证据的证据：心血管反应可预测临床前（血压升高，心室重构，颈动脉粥样硬化）和/或临床心血管疾病状态的发展。方法：回顾性文献进行审查前瞻性研究。结果：长期跟踪（20年或更长时间）的三项大型流行病学研究发现，对冷压任务的血压反应可预测初始血压正常样本中随后的原发性高血压。研究结果不一致的研究倾向于使用短期随访。大量文献表明，在1至6年的时间里，年轻人与压力有关的心血管反应与血压升高之间存在一致的联系。在成人样本中，这种关系尚未得到一致显示。迄今为止，在为数不多的前瞻性研究中，中度一致的证据表明反应性与其他亚临床疾病指标（左心室质量增加和颈动脉粥样硬化）之间存在正相关关系。但是，许多其他因素，例如疾病风险的基线水平和承受社会心理压力，似乎可以缓解这些关系。在最近的报告中，基线时的健康状况似乎也缓解了反应性与临床冠心病之间的关联：最初健康样品中的三项现有研究中有两项没有证据表明反应性与临床结局之间的关系，而四分之三的研究中，既往存在的冠心病或原发性高血压在反应性和随后的疾病状态之间显示出正相关关系。结论：有合理的证据表明心血管反应可以预测某些临床前状态（例如，左心室质量和血压增加）的发展，甚至可以预测某些原发性高血压或冠心病患者的新临床事件。然而，在正向关系的稳健性变得可用于临床之前，需要更多有关缓和和潜在混淆变量的信息。

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