Cardiovascular stress-response adaptation: Conceptual basis, empirical findings, and implications for disease processes

Cardiovascular reactivity to stress is an established marker of lifetime disease risk, with both elevated and blunted reactions empirically identified as being predictive of ill-health. However, in the relevant studies, traditional laboratory protocols do not account for patterns of response adaptation across time, patterns that may be particularly important in the prediction of future health outcomes. We outline the evidence suggesting that habituation to repeated or prolonged stress represents an informative and health-relevant aspect of the cardiovascular stress response. In this position paper, we outline what studies of cardiovascular adaptation have elucidated to date. Cardiovascular response habituation occurs for various types of stressor, is most pronounced after initial stress responses have subsided (making initial stress responses potentially misleading if scrutinized in isolation), emerges in both women and men, and is subject to individual differences. Such moderating factors fit within the biopsychosocial model, suggesting that CVR adaptation is etiologically relevant and potentially modifiable through intervention. However, as yet, there is no prospective evidence to confirm that patterns of adaptation predict adverse health, despite there being strong reasonable and logical grounds to suspect so. We suggest how existing studies may offer a means to fill this gap in prospective evidence, and outline four potential typologies in cardiovascular reactivity patterns that fit within and extend the classic reactivity hypothesis.