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.