Does stress cause hypertension?

From the Guidelines

Yes, stress can cause hypertension. Chronic stress has been associated with high blood pressure later in life, as noted in the 2020 international society of hypertension global hypertension practice guidelines 1.

Key Factors

• The relationship between stress and hypertension is supported by studies suggesting that randomized clinical trials examining the effects of transcendental meditation/mindfulness on blood pressure indicate that this practice lowers blood pressure 1.
• Reducing stress and inducing mindfulness is recommended as a lifestyle modification to manage hypertension 1.
• The exact mechanisms by which stress affects blood pressure are complex, but it is thought that stress hormones, such as adrenaline and cortisol, play a role in stimulating the body's "fight or flight" response, leading to blood vessel constriction and increased blood flow.

Management

• Regular aerobic and resistance exercise, such as walking, jogging, cycling, yoga, or swimming, for 30 minutes on 5–7 days per week, can help reduce blood pressure and manage stress 1.
• Mindfulness practices, such as meditation, can be introduced into daily routines to help reduce stress and lower blood pressure 1.
• A healthy diet, rich in whole grains, fruits, vegetables, polyunsaturated fats, and dairy products, can also help manage hypertension and reduce stress 1.

From the Research

Relationship Between Stress and Hypertension

• Stress has been shown to increase blood pressure by increasing cardiac output and heart rate without affecting total peripheral resistance 2.
• Acute stress increases levels of catecholamines, cortisol, vasopressin, endorphins, and aldosterone, which may contribute to the increase in blood pressure 2.
• Prolonged stress may predispose individuals to prolonged hypertension, and certain populations are at risk for the development of stress-induced hypertension 2.

Mechanisms of Stress-Induced Hypertension

• The activation of the sympathetic nervous system plays a primary role in stress-induced hypertension 2.
• Stress reduces renal sodium excretion, contributing to an increase in blood pressure 2.
• Adrenaline-mediated facilitation of neuronal noradrenaline release may amplify sympathetic pressor responses, leading to increased blood pressure 3.

Clinical Significance of Stress-Related Blood Pressure Changes

• Psychosocial stress contributes to the development and worsening of hypertension 4.
• White-coat hypertension, defined as high clinic blood pressure but normal out-of-office blood pressure, is a common stress-related blood pressure response 4.
• Masked hypertension, defined as high out-of-office blood pressure but normal office blood pressure, is a poor prognostic condition that may be related to chronic stress 4.

Hormonal Responses to Stress

• Vasopressin and oxytocin show specific responses to stress conditions, with vasopressin release increasing in response to certain stress stimuli 5.
• Oxytocin may be considered a typical stress hormone, responding to osmotic and other stress stimuli 5.

Stress-Related Changes in Body Form

• Stress is associated with body mass gain in some individuals but with body mass loss in others 6.
• The combined effects of stress exposure and autonomic variability predict long-term changes in body form, including increased waist-to-height ratio and body mass 6.