Stress Resilience – Hypertension
A new study published in the journal Heart indicates that men with low stress resilience during youth are prone to approximately 40% increase in the risk of developing hypertension in later life. Of note, the combination of low stress resilience and high body mass index (BMI) triples the hypertension risk.
High blood pressure is a costly and large growing public health problem worldwide. According to the World Health Organization (WHO), globally, the overall hypertension prevalence in adults was around 40% in 2008, whereas the number of people with uncontrolled hypertension rose from 600 million in 1980 to nearly 1 billion in 2008.
Adverse childhood family environment, ‘type A’ behavior patterns such as time urgency/impatience and hostile attitudes, chronic financial stress, anxiety and depression have been associated with a higher risk of hypertension. Studies also have reported that greater blood pressure reactivity to psychological stress is associated with subsequent development of hypertension. However, it appears that no studies have examined psychological assessment of stress resilience early in life in relation to hypertension risk in adulthood.
Besides the nutritional and genetic factors, greater stress reactivity is a well-known factor in the development of hypertension. Time urgency/impatience and hostility (two major components of the type A behavior pattern) are also associated with an increase in the long-term risk of hypertension.
However, the role of stress resilience – the individual’s ability to properly adapt to and handle stress – and how it can influence the risk of high blood pressure was not assessed previously.
In the Heart report, Casey Crump and colleagues from Stanford University, California, USA and the Lund University, Malmö, Sweden conducted a national cohort study of 1,547,182 military conscripts who entered into the Swedish army at 18 years of age.
The authors studied the Swedish Military Conscription Registry, between 1969 and 1997. Individuals underwent standardised psychological assessment by trained psychologists for stress resilience and were followed up for hypertension during the 1969–2012 period.
Stress resilience assessments were obtained from the Swedish Military Conscription Registry, which contains information from a 2-day standardised physical and psychological examination administered annually to all Swedish military conscripts starting in 1969. Stress resilience was assessed using a 20–30 min semi-structured interview administered by trained psychologists. The overall objective of the interview was to assess the conscript’s ability to cope with the psychological requirements of military service, including stress resilience during armed combat.
The researchers report that men with low resilience to stress at the age of 18 had an increased risk to develop hypertension in adulthood, which was independent of BMI at baseline, diabetes, family history of hypertension and socioeconomic factors.
Importantly, the authors found a positive additive interaction between stress resilience and BMI, where high BMI significantly magnified the risk of developing hypertension.
Thus, men with a combination of low stress resilience and high BMI had the highest risk of hypertension, which was more than threefold relative to the reference group who had high stress resilience and normal BMI. The interaction between low stress resilience and high BMI was non–significant on the multiplicative scale, but was highly significant on the additive scale, indicating that low stress resilience was associated with more hypertension cases among men with high BMI.
Thus, the study, although observational, suggests that the stress resilience-hypertension link may have an important long-term role in etiological pathways for hypertension. These pathways most likely are exaggerated in overweight individuals.
The mechanisms by which low stress resilience may contribute to the development of hypertension are complex and likely involve both physiological and behavioural factors. According to the ‘reactivity hypothesis’, exaggerated blood pressure responses to psychological stress may cause arterial damage and dysfunction over time, leading to the development of hypertension and cardiovascular disease.
The study also suggests that psychological interventions and stress management during late adolescence may be useful to prevent the development of cardiovascular pathologies in later life.
Source: Heart, 2016 Feb 1. pii: heartjnl-2015-308597. doi: 10.1136/heartjnl-2015-308597. [Epub ahead of print]
Read More: Heart Journal
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