Acute mental stress-induced adrenergic reactivity profiles predict distinct cardiometabolic risk trajectories over three years: the SABPA study.

Authors

Dewald Naudé, Wayne Smith, Roland von Känel, Annemarie Wentzel

Published in

Journal of hypertension. Oct 09, 2026. Epub Oct 09, 2026.

Abstract

We previously characterised acute mental stress-induced alpha (α)- and beta (β)-adrenergic-haemodynamic reactivity profiles cross-sectionally and related them to unique cardiometabolic risk outcomes. Whether these profiles predict future cardiometabolic risk remains unclear. We compared three-year cardiometabolic risk outcomes between predominant α- and β-responders and evaluated the prognostic value of each profile for predicting cardiometabolic risk.
Participants (aged 20-65 years) were stratified at baseline as predominant α- (n = 43) or β-responders (n = 59) defined by lowest and highest population quartiles, respectively, of reactivity in both cardiac output and Windkessel arterial compliance. Remaining participants were classified as mixed-α/β-responders (n = 227). Hypertension and central obesity at baseline and follow-up were defined using international guidelines. Other outcomes included cardiac stress (cardiac troponin-T ≥4.2 pg/ml), abnormal-glucose-tolerance (Abnl-GT; HbA1c ≥5.7% and/or fasting glucose ≥5.6 mmol/l and/or using antidiabetic medication), 10-year atherosclerotic cardiovascular disease (ASCVD)-risk (UCLA composite score), 24-h ischaemic events (Holter-electrocardiography) and an adverse lipid profile (high total cholesterol, low high-density-lipoprotein (HDL)-cholesterol and high triglycerides) defined by South African Heart Association/Lipid and Atherosclerosis Society of Southern Africa guidelines. Three-year risk for each outcome by adrenergic profile were estimated using covariate-adjusted Cox-proportional hazard models.
At three-year follow-up, α-responders had higher prevalence of hypertension, Abnl-GT, low HDL-cholesterol, and 10-year ASCVD-risk than β-responders (all P ≤ 0.025). Both α- and β-adrenergic reactivity profiles were associated with increased three-year risk of 10-year ASCVD, cardiac stress, central obesity, and Abnl-GT (all P ≤ 0.047). The α-adrenergic reactivity profile uniquely predicted elevated risk of hypertension, high total cholesterol, and low HDL-cholesterol (all P ≤ 0.009), whereas the β-adrenergic reactivity profile was associated with lower risk of hypertension and high total cholesterol but higher risk of 24-h ischaemic events (all P ≤ 0.016).
Acute mental stress-induced α- and β-adrenergic reactivity profiles independently predicted distinct cardiometabolic outcomes over three-years, delineating differential pathways of cardiometabolic risk. These findings support the potential utility of adrenergic reactivity phenotypes to refine individual, psychophysiological-linked cardiometabolic risk stratification.

PMID:
42853128
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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