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Original article

Vol. 148 No. 4950 (2018)

Association of allostatic load with health-related quality of life in patients with arterial hypertension: a cross-sectional analysis

  • Franziska Matzer
  • Christian Fazekas
  • Christian Vajda
  • Stefan Pilz
  • Verena Schwetz
  • Christian Trummer
  • Marlene Pandis
  • Andreas Tomaschitz
  • Isabella Petsch
  • Barbara Obermayer-Pietsch
  • Thomas Pieber
  • Hans-Peter Kapfhammer
DOI
https://doi.org/10.4414/smw.2018.14689
Cite this as:
Swiss Med Wkly. 2018;148:w14689
Published
04.01.2019

Summary

AIMS OF THE STUDY

Allostatic load (AL), as a marker of cumulative stress, is associated with higher morbidity and mortality, and reduced health-related quality of life (HrQoL) in healthy adults. In patients with hypertension, AL and its association with HrQoL have not been investigated. Therefore, this study aimed to (1) explore AL in a cohort of hypertensive patients and to (2) determine its association with HrQoL, while controlling for other health-related variables.

METHODS

Cross-sectional data from the Styrian Hypertension Study were analysed and included 126 participants (50% female) with a history of arterial hypertension; the mean age was 60.9 years (standard deviation 9.9). AL was derived from a set of 10 biomarkers including neurophysiological, neuroendocrine, metabolic, cardiovascular and inflammatory parameters. The 36-Item Short Form Health Survey (SF-36) was administered for assessment of HrQoL. Additional health-related variables included sociodemographic data, lifestyle factors and comorbidities.

RESULTS

Calculation of AL resulted in sum scores based on 10 binary variables, which were used to categorise patients as either “low AL” (<3) or “high AL” (≥3). Multivariate adjusted analyses revealed that higher AL was associated with better HrQoL with regard to the mental health domain F(1,1243) = 7.017; p = 0.009). All other components of HrQoL were not related to AL.

CONCLUSIONS

In contrast to results in healthy populations, we found a positive association between AL and the mental health domain of HrQoL. This finding suggests a specific coping pattern among a subgroup of hypertensive patients, possibly influencing their clinical management and outcome.

References

  1. Sterling P, Eyer J. Allostasis: A New Paradigm to Explain Arousal Pathology. In: Fisher S, Reason J, editors. Handbook of Life Stress, Cognition and Health. New York: John Wiley &Sons; 1988. pp. 629-649.
  2. McEwen BS, Stellar E. Stress and the individual. Mechanisms leading to disease. Arch Intern Med. 1993;153(18):2093–101. doi:.https://doi.org/10.1001/archinte.1993.00410180039004
  3. Mauss D, Li J, Schmidt B, Angerer P, Jarczok MN. Measuring allostatic load in the workforce: a systematic review. Ind Health. 2015;53(1):5–20. doi:.https://doi.org/10.2486/indhealth.2014-0122
  4. Sterling P. Allostasis: a model of predictive regulation. Physiol Behav. 2012;106(1):5–15. doi:.https://doi.org/10.1016/j.physbeh.2011.06.004
  5. Beckie TM. A systematic review of allostatic load, health, and health disparities. Biol Res Nurs. 2012;14(4):311–46. doi:.https://doi.org/10.1177/1099800412455688
  6. Seeman T, Gruenewald T, Karlamangla A, Sidney S, Liu K, McEwen B, et al. Modeling multisystem biological risk in young adults: The Coronary Artery Risk Development in Young Adults Study. Am J Hum Biol. 2010;22(4):463–72. doi:.https://doi.org/10.1002/ajhb.21018
  7. McCaffery JM, Marsland AL, Strohacker K, Muldoon MF, Manuck SB. Factor structure underlying components of allostatic load. PLoS One. 2012;7(10):e47246. doi:.https://doi.org/10.1371/journal.pone.0047246
  8. Wiley JF, Gruenewald TL, Karlamangla AS, Seeman TE. Modeling multisystem physiological dysregulation. Psychosom Med. 2016;78(3):290–301. doi:.https://doi.org/10.1097/PSY.0000000000000288
  9. Carlsson AC, Nixon Andreasson A, Wändell PE. Poor self-rated health is not associated with a high total allostatic load in type 2 diabetic patients--but high blood pressure is. Diabetes Metab. 2011;37(5):446–51. doi:.https://doi.org/10.1016/j.diabet.2011.03.005
  10. Steptoe A, Hackett RA, Lazzarino AI, Bostock S, La Marca R, Carvalho LA, et al. Disruption of multisystem responses to stress in type 2 diabetes: investigating the dynamics of allostatic load. Proc Natl Acad Sci USA. 2014;111(44):15693–8. doi:.https://doi.org/10.1073/pnas.1410401111
  11. Nobel L, Roblin DW, Becker ER, Druss BG, Joski PI, Allison JJ. Index of cardiometabolic health: a new method of measuring allostatic load using electronic health records. Biomarkers. 2017;22(5):394–402. doi:.https://doi.org/10.1080/1354750X.2016.1201535
  12. Vie TL, Hufthammer KO, Holmen TL, Meland E, Breidablik HJ. Is self-rated health a stable and predictive factor for allostatic load in early adulthood? Findings from the Nord Trøndelag Health Study (HUNT). Soc Sci Med. 2014;117:1–9. doi:.https://doi.org/10.1016/j.socscimed.2014.07.019
  13. Trevisol DJ, Moreira LB, Kerkhoff A, Fuchs SC, Fuchs FD. Health-related quality of life and hypertension: a systematic review and meta-analysis of observational studies. J Hypertens. 2011;29(2):179–88. doi:.https://doi.org/10.1097/HJH.0b013e328340d76f
  14. Mollaoğlu M, Solmaz G, Mollaoğlu M. Adherence to Therapy and Quality of Life in Hypertensive Patients. Acta Clin Croat. 2015;54(4):438–44.
  15. Strandberg AY, Strandberg TE, Stenholm S, Salomaa VV, Pitkälä KH, Tilvis RS. Low midlife blood pressure, survival, comorbidity, and health-related quality of life in old age: the Helsinki Businessmen Study. J Hypertens. 2014;32(9):1797–804. doi:.https://doi.org/10.1097/HJH.0000000000000265
  16. Grübler MR, Kienreich K, Gaksch M, Verheyen N, Fahrleitner-Pammer A, Schmid J, et al. Aldosterone to active renin ratio is associated with nocturnal blood pressure in obese and treated hypertensive patients: the Styrian Hypertension Study. J Clin Hypertens (Greenwich). 2014;16(4):289–94. doi:.https://doi.org/10.1111/jch.12274
  17. ó Hartaigh B, Gaksch M, Kienreich K, Grübler MR, Verheyen N, März W, et al. Associations of daytime, nighttime, and 24-hour heart rate with four distinct markers of inflammation in hypertensive patients: the Styrian Hypertension Study. J Clin Hypertens (Greenwich). 2014;16(12):856–61. doi:.https://doi.org/10.1111/jch.12420
  18. Pilz S, Gaksch M, Kienreich K, Grübler M, Verheyen N, Fahrleitner-Pammer A, et al. Effects of vitamin D on blood pressure and cardiovascular risk factors: a randomized controlled trial. Hypertension. 2015;65(6):1195–201. doi:.https://doi.org/10.1161/HYPERTENSIONAHA.115.05319
  19. Verheyen ND, Kienreich K, Gaksch M, van Ballegooijen AJ, Grübler MR, Hartaigh BO, et al. Plasma Parathyroid Hormone Is Independently Related to Nocturnal Blood Pressure in Hypertensive Patients: The Styrian Hypertension Study. J Clin Hypertens (Greenwich). 2016;18(6):543–50. doi:.https://doi.org/10.1111/jch.12710
  20. Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS. Price of adaptation--allostatic load and its health consequences. MacArthur studies of successful aging. Arch Intern Med. 1997;157(19):2259–68. doi:.https://doi.org/10.1001/archinte.1997.00440400111013
  21. Frei R, Haile SR, Mutsch M, Rohrmann S. Relationship of Serum Vitamin D Concentrations and Allostatic Load as a Measure of Cumulative Biological Risk among the US Population: A Cross-Sectional Study. PLoS One. 2015;10(10):e0139217. doi:.https://doi.org/10.1371/journal.pone.0139217
  22. Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83. doi:.https://doi.org/10.1097/00005650-199206000-00002
  23. Bullinger M, Kirchberger I. Fragebogen zum Gesundheitszustand SF-36. Handanweisung. Göttingen: Hogrefe; 1998.
  24. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. Geneva: WHO; 2000.
  25. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–95. doi:.https://doi.org/10.1249/01.MSS.0000078924.61453.FB
  26. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al.; Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and the European Society of Cardiology. 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension. Blood Press. 2014;23(1):3–16. doi:.https://doi.org/10.3109/08037051.2014.868629
  27. World Health Organization, Regional Office for Europe, ed. Use of well-being measures in primary health care - the DepCare project health for all. Target 12. Geneva: WHO; 1998.
  28. Heun R, Bonsignore M, Barkow K, Jessen F. Validity of the five-item WHO Well-Being Index (WHO-5) in an elderly population. Eur Arch Psychiatry Clin Neurosci. 2001;251(Suppl 2):27–31. doi:.https://doi.org/10.1007/BF03035123
  29. Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167–76. doi:.https://doi.org/10.1159/000376585
  30. Glass GV, Peckham PD, Sanders JR. Consequences of Failure to Meet Assumptions Underlying the Fixed Effects Analyses of Variance and Covariance. Rev Educ Res. 1972;42(3):237–88. doi:.https://doi.org/10.3102/00346543042003237
  31. Salkind NJ. Encyclopedia of Research Design (Vol. 2). Los Angeles: Sage; 2010.
  32. Pagano RR. Understanding statistics in the behavioral sciences (9th ed.). Australia, Belmont, CA: Thomson Wadsworth; 2010.
  33. Borrell LN, Dallo FJ, Nguyen N. Racial/ethnic disparities in all-cause mortality in U.S. adults: the effect of allostatic load. Public Health Rep. 2010;125(6):810–6. doi:.https://doi.org/10.1177/003335491012500608
  34. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev. 2010;35(1):2–16. doi:.https://doi.org/10.1016/j.neubiorev.2009.10.002
  35. Seplaki CL, Goldman N, Weinstein M, Lin YH. How are biomarkers related to physical and mental well-being? J Gerontol A Biol Sci Med Sci. 2004;59(3):B201–17. doi:.https://doi.org/10.1093/gerona/59.3.B201
  36. Seplaki CL, Goldman N, Weinstein M, Lin YH. Measurement of cumulative physiological dysregulation in an older population. Demography. 2006;43(1):165–83. doi:.https://doi.org/10.1353/dem.2006.0009
  37. Mena-Martin FJ, Martin-Escudero JC, Simal-Blanco F, Carretero-Ares JL, Arzua-Mouronte D, Herreros-Fernandez V. Health-related quality of life of subjects with known and unknown hypertension: results from the population-based Hortega study. J Hypertens. 2003;21(7):1283–9. doi:.https://doi.org/10.1097/00004872-200307000-00015
  38. Janssens T, Harver A. Effects of Symptom Perception Interventions on Trigger Identification and Quality of Life in Children with Asthma. Pulm Med. 2015;2015:825137. doi:.https://doi.org/10.1155/2015/825137
  39. Hayward J, Millar L, Petersen S, Swinburn B, Lewis AJ. When ignorance is bliss: weight perception, body mass index and quality of life in adolescents. Int J Obes. 2014;38(10):1328–34. doi:.https://doi.org/10.1038/ijo.2014.78
  40. Dich N, Lange T, Head J, Rod NH. Work stress, caregiving, and allostatic load: prospective results from the Whitehall II cohort study. Psychosom Med. 2015;77(5):539–47. doi:.https://doi.org/10.1097/PSY.0000000000000191
  41. Seeman T, Epel E, Gruenewald T, Karlamangla A, McEwen BS. Socio-economic differentials in peripheral biology: cumulative allostatic load. Ann N Y Acad Sci. 2010;1186(1):223–39. doi:.https://doi.org/10.1111/j.1749-6632.2009.05341.x
  42. Wiley JF, Bei B, Bower JE, Stanton AL. Relationship of psychosocial resources with allostatic load: a systematic review. Psychosom Med. 2017;79(3):283–92. doi:.https://doi.org/10.1097/PSY.0000000000000395