Does psychosocial stress cause hypertension? A systematic review of observational studies

Abstract

Acute stress promotes transient elevation of blood pressure, but there is no consistent evidence that this effect results in hypertension. In this systematic review of cohort and case-control studies that investigated the association between psychosocial stress and hypertension, we conducted a complete search up to February 2007 in MEDLINE, EMBASE, PSYCINFO and LILACS, through a search strategy that included eight terms to describe the exposure, six related to the design of the studies and one term for outcome. The quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. The selection was done in duplicate by two teams of independent reviewers. Among 82 studies selected in the second phase, only 14 (10 cohort studies and 4 case-control studies), totalling 52 049 individuals, fulfilled the selection criteria. The average quality of the studies was 6.6 ± 1.3 in a 9-point scale. Acute life events were associated with hypertension in one and were not associated in two studies. Five out of seven studies found a significant and positive association between measures of chronic stress and hypertension, with risk ratios ranging from 0.8 to 11.1. Three out of five studies reported high and significant risks of affective response to stress for hypertension, one a significant risk close to a unit and one reported absence of risk. Acute stress is probably not a risk factor for hypertension. Chronic stress and particularly the non-adaptive response to stress are more likely causes of sustained elevation of blood pressure. Studies with better quality are warranted.

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

“…Although literature has focused more on acute and mental health consequences of exposure to conflict and displacement, 33 those who survive may experience long-term effects that similarly threaten their health and lives, Displacement results in socio-cultural, psychosocial, and physiological stressors. 32,34 These stressors can set in motion a series of physiological changes that have been clearly linked to hypertension [35][36][37][38] as well as other chronic health risks.…”

Differences in emotional personality traits and stress between sustained hypertension and normotension

“…In sum, our results support our hypothesis concerning differences in emotional personality traits and stress between normotension and sustained hypertension, and are consistent with those obtained in previous studies that also support the role of trait anxiety and stress in hypertension. [1][2][3][4]6,7 Of course, there are studies that have failed to show differences in trait anxiety, depression and stress between normotensives and hypertensives. 8,10,12 However, most of these studies did not use, along with clinic BPs, out-of-clinic (self-measured or ambulatory) BPs to diagnose hypertension, and therefore they were not able to detect and control isolated clinic hypertension.…”

“…[1][2][3][4][5] However, such associations are small and highly variable, and further studies are warranted because inconsistent results have been frequently reported.…”

“…4 However, other studies have failed to show differences between normotensives and hypertensives in trait anxiety, 8 trait anger 9 and stress. 10 Concerning trait depression, the data linking this emotional trait to hypertension are indirect and at best ambiguous.…”

Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving

“…These findings clearly show the potential for physical health risks for boomer caregivers. Research shows that chronic stress, particularly the non-adaptive response to stress, is the more likely cause of sustained elevation of blood pressure [16]. Given that dementia caregiving is associated with chronic stress, the caregivers in this study are at risk for sustained elevation of blood pressure, which is associated with a cascade of life-threatening diseases that can affect the heart, brain and kidneys [17].…”