MacArthur SES & Health Network
MacArthur SES & Health Network

printable version

Cardiovascular Measures of Allostatic Load

Summary prepared by Thomas Pickering in collaboration with the Allostatic Load Working Group. Last revised June, 1997.

Blood Pressure

  • Both genetically and environmentally determined; interventions in early life may have permanent effects.
  • Tends to track in a predictable way in individuals, but course may be altered by environmental factors.
  • Can be conceptualized as tonic and phasic components; hypertensives show elevated tonic level, without much change in phasic (variability).
  • Adverse effects thought to be largely due to tonic component; phasic may contribute to triggering of acute events, e.g. atherosclerotic plaque rupture.
  • Chronic environmental stress (e.g. job strain) can reset tonic component (i.e. BP raised to same extent throughout 24 hours in men with high strain jobs).
  • Conventional clinic or casual measurement of BP gives imprecise estimate of true BP level, for several reasons: few readings, taken in unrepresentative setting; confounding effect of observer (white coat effect).
  • Ambulatory monitoring (ABPM) can give accurate estimate of true (tonic) BP level, and limited information about phasic component. Beat-to-beat ABPM is available, but cumbersome & expensive.
  • Sympathetic NS is likely mediator of environmental effects on BP, including calories (obesity), sodium, and stress.

Left Ventricular Structure Function (Echocardiography)

  • Left ventricular mass can be reliably assessed by echo, and represents cumulative effects of BP on the heart.
  • Also influenced by other genetic environmental factors.
  • Is an independent risk factor for cardiovascular morbidity.
  • Cardiac function can be assessed as cardiac output, peripheral resistance, and ejection fraction, all of which are dynamic rather than structural measures.


UCSF Home About UCSF Search UCSF UCSF Medical Center