Psychosocial Factors and Risk of Hypertension

Abstract

Context Although psychosocial factors are correlated, previous studies on risk factors for hypertension have typically examined psychosocial factors individually and have yielded inconsistent findings. Objective To examine the role of psychosocial factors of time urgency/impatience (TUI), achievement striving/competitiveness (ASC), hostility, depression, and anxiety on long-term risk of hypertension. Design, Setting, and Study Population A population-based, prospective, observational study using participant data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. A total of 3308 black and white adults aged 18 to 30 years (when recruited in 1985 and 1986) from 4 US metropolitan areas and followed up through 2000 to 2001. Main Outcome Measures Fifteen-year cumulative incidence of hypertension (systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or taking antihypertensive medication). Results The incidence of hypertension at year 15 was 15% from baseline and 13.6% from year 5. After adjusting for the same set of hypertension risk factors and each of the psychosocial factors of TUI, ASC, hostility, depression, and anxiety in 5 separate logistic regression models, higher TUI and hostility were significantly associated with risk of developing hypertension at 15-year follow-up for the total sample. Compared with the lowest score group, the adjusted odds ratio (OR) for TUI was 1.51 (95% confidence interval [CI], 1.12-2.03) for a score of 1; 1.47 (95% CI, 1.08-2.02) for a score of 2; and 1.84 (95% CI, 1.29-2.62) for a score of 3 to 4 (P for trend=.001). Compared with the lowest quartile group, the adjusted OR for hostility was 1.06 (95% CI, 0.76-1.47) for quartile 2; 1.38 (95% CI, 1.00-1.91) for quartile 3; and 1.84 (95% CI, 1.33-2.54) for quartile 4 (P for trend Ͻ.001). No consistent patterns were found for ASC, depression, or anxiety. Raceand sex-specific analyses and multivariable models with simultaneous adjustment for all 5 psychosocial factors and other hypertension risk factors had generally similar results. Conclusion Among young adults, TUI and hostility were associated with a doseresponse increase in the long-term risk of hypertension.

Hypertension – A Possible Vulnerability Marker for Depression in Patients with End-Stage Renal Disease

“…Whether or not depression causes or is caused by medical diseases, such as hypertension, is a matter of dispute. Some researchers believe that individuals with severe depressive symptoms have an increased risk of developing many medical illnesses, notably stroke, hypertension [6,7,8,9]. On the other hand, several studies support the notion that chronic medical diseases, such as uremia and diabetes mellitus, enhance the impact of depressed mood [1, 2, 10, 11].…”

“…The relationship between depression and hypertension is biologically plausible given the increased adrenergic activity in depression that may have a pressor effect on the cardiovascular system [15]. Most studies suggest that there is an association between hypertension and depression [1, 2,6,7,8,9,10,11], but the cause of this association is still unclear.…”

“…Hypertension has long been established as a strong, independent and etiologically significant risk factor for cardiovascular disease [9]. A growing body of evidence supports the thesis that psychosocial factors, such as depressive symptoms and anxiety, play a role in the pathogenesis of hypertension [19].…”

“…A growing body of evidence supports the thesis that psychosocial factors, such as depressive symptoms and anxiety, play a role in the pathogenesis of hypertension [19]. While some evidence supports the biological plausibility of psychosocial factors as risk factors for hypertension [6,7,8,9], other explanations for the relationship have not been adequately explored [1, 2]. However, if depression is co-occurring in both ESRD and the hypertension commonly accompanying medical disease, what is the role of hypertension in ESRD patients with depression?…”

Hypertension: An Overview

“…20 Long term chronic exposure to psychological stress can cause increased blood pressure which can develop as hypertension. 21 A study of over 3,000 individuals 22 showed that urgency/impatience behavior, and hostility assessed during young adulthood along with depression and anxiety were the strong reasons for developing hypertension after 15 years. Financial strain lead to chronic stress has been reported to predict high blood pressure during three to seven years of follow-up.…”