Psychological Factors and Blood Pressure Responses to Acute Stress in Women with Takotsubo Syndrome: An Exploratory Study

Aims: This secondary analysis aimed to: 1) describe psychological resources and distress in women with Takotsubo Syndrome (TS), and 2) explore whether such factors affect blood pressure (BP) responses to acute mental stress.

Methods and results: Participants were 47 women consecutively enrolled in an ongoing study examining the prognostic significance of stress reactivity in TS. Psychological resources (resilience, adaptive coping) and distress (depression, anxiety, PTSD, perceived stress) were self-reported using validated questionnaires <12 weeks after TS. Using a standardized protocol, systolic BP (SBP) and diastolic BP (DBP) (mmHg) were measured every 5 minutes during baseline (10 min), mental stress (10 min), and recovery (20 min). Associations of psychological resources and distress (high vs. low composite scores), respectively, with BP during mental stress and recovery (change from baseline) were examined using one-way ANCOVAs (covariates: age, anti-hypertensive medications). Given the study's exploratory nature, results are shown as effect sizes.On average, women (Mage= 64.3 years) had high perceived stress, anxiety, and PTSD symptoms and low resilience. Women with high (vs. low) psychological distress displayed less complete SBP (d=.57) and DBP (d=.33) recovery to baseline. Women with low (vs. high) psychological resources demonstrated lower SBP responses during mental stress (d=-.26) alongside a more complete SBP recovery (d=.30).

Conclusion: Female survivors of TS with high psychological distress exhibited impaired BP recovery following acute mental stress. While the prognostic significance of impaired BP recovery from mental stress remains to be determined in longitudinal studies, this finding could help identify TS survivors at risk for recurrence.