Cardiovascular Stress Physiology and Interoceptive Pathways to Brain Aging and Health

OBJECTIVE: Individuals with a phenotypic tendency to react to acute psychological stressors with large and prolonged rises in blood pressure (stressor-evoked blood pressure reactivity) may be at risk for hypertension and adverse cardiovascular outcomes. The latter outcomes themselves drive cerebrovascular disease and later-life dementias. At issue here is the plausibility of whether stressor-evoked blood pressure reactivity could be considered as a form of cardiovascular stress physiology that relates to cerebrovascular disease and dementia vulnerability via "bottom-up" or interoceptive pathways of the brain-heart axis. METHOD: This Scientific Spotlight describes a heuristic Neurovascular Burden of Stress hypothesis on cardiovascular physiology and interoceptive pathways to neurovascular pathology within the brain. Results: Some evidence in need of replication suggests that stressor-evoked blood pressure reactivity relates to white matter brain lesions; risk for ischemic strokes; and, higher rates of vascular determinants of dementia. CONCLUSIONS: A new generation of research is needed to understand the interoceptive pathways by which cardiovascular stress physiology could predispose to cerebrovascular disease and dementia, as well as to identify biopsychosocial factors that could be modified to support healthy brain aging.