Change in urinary cortisol excretion mediates the effect of angry/hostile mood on 9 month diastolic blood pressure in HIV+ adults
Change in urinary cortisol excretion mediates the effect of angry/hostile mood on 9 month diastolic blood pressure in HIV+ adults
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尿皮质醇排泄的变化介导愤怒/敌对情绪对 HIV 成人 9 个月舒张压的影响
DOI：
10.1007/s10865-017-9827-1
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发表时间：
2017
影响因子：
3.1
通讯作者：
N. Schneiderman
中科院分区：
文献类型：
--
作者：
R. McIntosh;M. Antoni;A. Carrico;R. Durán;B. Hurwitz;G. Ironson;M. Fletcher;N. Klimas;Mahendra Kumar;N. Schneiderman
心血管疾病是艾滋病毒疾病管理中日益令人关切的问题，近三分之一的病毒感染者患有高血压。生物行为因素，如愤怒，敌意和HPA轴反应性与血压调节有关。在HIV感染者中，HPA轴或情绪障碍是否增加高血压的风险尚不清楚。本研究的目的是确定9个月的愤怒/敌对情绪的变化是否预示着收缩压（SBP）或舒张压（DBP）的变化，以及这种变化是否由24小时尿皮质醇（CORT）输出介导。61名年龄为41.1 ± 8.6岁的HIV阳性成年人被分配到压力管理干预的对照组，他们提供了血液样本、24小时尿液样本、办公室血压以及基线和9个月随访时自我报告的情绪。在两个独立的模型中，CORT被测试为介体，控制基线BP、CD 4计数、HIV-1病毒载量、蛋白酶抑制剂使用、体重指数、吸烟状况和心脏代谢疾病家族史。随访时，愤怒/敌对情绪的增加与较高的SBP（β = 0.33，CI 0.09，0.56，p = 0.01）和DBP（β = 0.39，CI 0.16，0.62，p < 0.001）相关。CORT部分介导愤怒/敌对情绪对DBP的影响（β = 0.28，CI 0.03，0.54，p = 0.03）。CORT的变化与SBP无关（β = 0.12，CI −0.20，0.44，p = 0.46）。最终的中介模型解释了9个月DBP的41.2%的方差。愤怒或敌对情绪可能通过干扰HPA轴导致接受HIV治疗的患者高血压风险增加。
Cardiovascular disease is a growing concern in HIV disease management and nearly 1 out of 3 persons living with the virus is hypertensive. Biobehavioral factors such as anger, hostility, and HPA axis reactivity are emperically linked to blood pressure regulation. Whether HPA axis or mood disturbance increases risk for hypertension remains unclear in HIV disease. The aim of this study was to determine whether 9-month change in angry/hostile mood predicts alterations in systolic (SBP) or diastolic blood pressure (DBP), and whether this change is mediated by 24-h urinary cortisol (CORT) output. Sixty-one HIV positive adults, aged 41.1 ± 8.6 years, assigned to the control condition of a stress management intervention provided blood samples, 24-h urine specimens, blood pressure in-office, and self-reported mood at baseline and a 9-month follow-up. CORT was tested as a mediator in two separate models controlling for baseline BP, CD4 count, HIV-1 viral load, protease inhibitor use, body mass index, smoking status, and family history of cardiometabolic disease. Increase in angry/hostile mood was associated with greater SBP (β = 0.33, CI 0.09, 0.56,p= 0.01) and DBP (β = 0.39, CI 0.16, 0.62,p< 0.001) at follow-up. CORT partially mediated the effect of angry/hostile mood on DBP (β = 0.28, CI 0.03, 0.54,p= 0.03). Change in CORT was not related to SBP (β = 0.12, CI −0.20, 0.44,p= 0.46). The final mediation model accounted for 41.2% of the variance in 9-month DBP. Angry or hostile mood may contribute to increased risk for hypertension in persons treated for HIV via disturbance of the HPA-axis.