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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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Abstract

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.

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Authors and Affiliations

  1. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Roger C. McIntosh, Michael Antoni, Barry E. Hurwitz, Gail Ironson & Neil Schneiderman

  2. Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

    Michael Antoni

  3. Behavioral Medicine Research Center, Miller School of Medicine, University of Miami, Miami, FL, USA

    Michael Antoni, Barry E. Hurwitz & Neil Schneiderman

  4. Department of Community Health Systems, University of California, San Francisco, CA, USA

    Adam Carrico

  5. Division of Endocrinology, Diabetes and Metabolism, School of Medicine, University of Miami, Miami, FL, USA

    Michael Antoni & Barry E. Hurwitz

  6. Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA

    Barry E. Hurwitz

  7. Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA

    Mahendra Kumar

  8. Miami Veterans Affairs Medical Center, Miami, FL, USA

    Mary Ann Fletcher, Nancy Klimas & Neil Schneiderman

  9. Institute for Neuro-immune Medicine, Nova Southeastern University, Davie, FL, USA

    Mary Ann Fletcher & Nancy Klimas

  10. Alliant International University, Alhambra, CA, USA

    Ron Duran

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  1. Roger C. McIntosh
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Roger C. McIntosh, Michael Antoni, Adam Carrico, Ron Duran, Barry E. Hurwitz, Gail Ironson, Mary Ann Fletcher, Nancy Klimas, Mahendra Kumar and Neil Schneiderman declare that they have no conflict of interest.

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All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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McIntosh, R.C., Antoni, M., Carrico, A. et al. Change in urinary cortisol excretion mediates the effect of angry/hostile mood on 9 month diastolic blood pressure in HIV+ adults. J Behav Med 40, 620–630 (2017). https://doi.org/10.1007/s10865-017-9827-1

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