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Exercise thallium tomography and 24-hour Holter monitoring were also performed. Hemodynamic changes were monitored during both stressors. Siblings positive for exercise-induced ischemia were offered cardiac catheterization. During mental stress, siblings with an abnormal exercise ECG and\/or thallium scan (n=15) had greater maximal increases in systolic blood pressure (SBP,\n            <jats:italic>P<\/jats:italic>\n            =.0004) and diastolic blood pressure (DBP,\n            <jats:italic>P<\/jats:italic>\n            =.05) and had greater heart rate variability in the normalized low frequency domain of an analysis of Holter monitor recordings, compared with siblings without exercise-induced ischemia. Coronary arteriography confirmed coronary atherosclerosis in 85% of siblings with exercise-induced ischemia. Regression analyses showed that occult ischemia during exercise was a strong independent predictor of maximal change in SBP and DBP during mental stress. A multivariate logistic model demonstrated that siblings with exercise-induced occult ischemia were 21 times more likely to be \u201chot\u201d responders (top quartile of change in SBP and DBP) during mental stress.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            An exaggerated cardiovascular response to mental stress is associated with exercise-induced myocardial ischemia in persons with preclinical coronary heart disease.\n          <\/jats:p>","DOI":"10.1161\/01.cir.96.12.4246","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:41:02Z","timestamp":1339461662000},"page":"4246-4253","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Exaggerated Reactivity to Mental Stress Is Associated With Exercise-Induced Myocardial Ischemia in an Asymptomatic High-Risk Population"],"prefix":"10.1161","volume":"96","author":[{"given":"Brian G.","family":"Kral","sequence":"first","affiliation":[{"name":"From the Division of Cardiology and the Center for Health Promotion, the Johns Hopkins Medical Institutions, Baltimore, Md."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lewis C.","family":"Becker","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology and the Center for Health Promotion, the Johns Hopkins Medical Institutions, Baltimore, Md."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger S.","family":"Blumenthal","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology and the Center for Health Promotion, the Johns Hopkins Medical Institutions, Baltimore, Md."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Aversano","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology and the Center for Health Promotion, the Johns Hopkins Medical Institutions, Baltimore, Md."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee A.","family":"Fleisher","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology and the Center for Health Promotion, the Johns Hopkins Medical Institutions, Baltimore, Md."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael M.","family":"Yook","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology and the Center for Health Promotion, the Johns Hopkins Medical Institutions, Baltimore, Md."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane M.","family":"Becker","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology and the Center for Health Promotion, the Johns Hopkins Medical Institutions, Baltimore, Md."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(90)90112-H"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(69)92645-2"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-199401000-00009"},{"key":"e_1_3_2_4_2","first-page":"137","volume":"1","year":"1987","unstructured":"McKinney ME, McIlvain HE, Hofschire PJ, Collins RE, Somers JA, Ruddel H, Buell JC, Eliot RS. 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