Blood Pressure and Emotional Responses to Stress: Perspectives on Cardiovascular Reactivity Clayton Hilmert* and Lexi Kvasnicka North Dakota State University Abstract It has long been thought that increases in blood pressure in response to stress are associated with emotional responses to stress. The health implications of such an association are clear; excessive emotional reactivity leads to excessive cardiovascular reactivity (CVR), which is associated with cardiovascular disease. However, the data do not support a strong association between CVR and emotional responses to acute stress. This lack of support has lead to research that interprets CVR to stress in at least three different ways: (1) as a potential contributor to disease development, (2) as an index of active coping, or (3) as a multidimensional construct that is affected by cognitive appraisals of a situation. In this article, we review these separate perspectives on CVR and suggest that a multidimensional perspective of CVR and emotional responding to stress may help integrate the CVR – health, effort, and appraisal points of view. …we may feel nearly sure that any sensation or emotion, as great pain or rage, which has habitually lead to much muscular action, will immediately influence the flow of nerve-force to the heart, although there may not be at the time any muscular exertion (Darwin, 1898, p. 74). A long held belief articulated here by Charles Darwin in The Expression of Emotion in Man and Animals (originally published in 1872) is that strong negative emotions directly influence the activity of the cardiovascular system. Despite this commonly held intuition, it has been difficult to demonstrate associations between emotions and cardiovascular reactivity (CVR) to stress. This is particularly true in laboratory stress-response research where reported correlations between emotional responses to stress and CVR are generally weak and inconsistent (rs range from 0.13 to 0.34; Feldman et al., 1999). Thus, the underlying psychology of CVR is unclear, and this has lead to inconsistent interpretations of cardiovascular responses to stress and the implications of these responses. There are various possible reasons why correlations between negative emotional and cardiovascular responses to stress have been weak and inconsistent. Traditional measure- ment (Hilmert & Kvasnicka, forthcoming) and experimental methods (Gerin et al., 1999) may not be optimal for detecting this association. On the other hand, negative emotions may not be as closely linked to CVR as assumed. Other variables, like effort, may deter- mine CVR (Wright & Kirby, 2001) and negative emotion may be unrelated or a minor determinant. It is also possible that associations between negative emotions and CVR are moderated by other variables, so that in certain circumstances, there is a stronger associa- tion than in others. Because large magnitude CVR in response to stress has been implicated in the devel- opment of cardiovascular disease (Lovallo & Gerin, 2003), a great deal of research has sought to identify the individual and situational factors predictive of these responses. This way, we may be able to better identify those at risk of CVR-related disease. A better Social and Personality Psychology Compass 4/7 (2010): 470–483, 10.1111/j.1751-9004.2010.00275.x ª 2010 The Authors Journal Compilation ª 2010 Blackwell Publishing Ltd