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Do any kinds of perceived stressors lead to hypertension? A longitudinal cohort study

Hypertension Research volume 45, pages 1058–1066 (2022)Cite this article

Abstract

Stress has been suggested as a contributing factor in the etiology and progression of hypertension in prior investigations. For a more comprehensive understanding of this concept, in this study, we aim to evaluate different domains of perceived stress and their possible contribution to the development of hypertension (HTN). This is a secondary analysis of the Isfahan Cohort Study (ICS). We used data from 2007 and 2013. The 12-item General Health Questionnaire (GHQ-12) and Stressful Life Events Questionnaire (SLEQ) were used to evaluate psychological distress and perceived stress in subjects, and a generalized linear mixed model (GLMM) was used to assess their association with HTN. Psychological distress had a significant positive relation with HTN that remained after full adjustment for other covariates. Individuals with high stress levels were 38% more likely to develop HTN (OR 1.38, 95% CI 1.18, 1.59). After full adjustment, total perceived stress was significantly associated with a 15% increase in HTN development (OR 1.15, 95% CI 1.01–1.29). Domains of perceived stress that were significantly associated with HTN independent of sociodemographic and lifestyle covariates were job conflict, job security, personal conflict, sexual life and daily life in both genders and financial problems in males (P < 0.01). The findings from this study underline the importance of identifying the effect of different sources of perceived stress to organize community-based strategies for the management of hypertension and help health professionals prioritize and efficiently allocate their resources for interventions.

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References

  1. Salem H, Hasan DM, Eameash A, El-Mageed HA, Hasan S, Ali R. Worldwide prevalence of hypertension: a pooled meta-analysis of 1670 studies in 71 countries with 29.5 million participants. J Am Coll Cardiol. 2018;71:A1819.

    Article  Google Scholar 

  2. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16:223–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. van Kleef MEAM, Spiering W. Hypertension: overly important but under-controlled. Eur J Prev Cardiol. 2017;24:36–43.

    Article  PubMed  Google Scholar 

  4. Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298:1685–1687.

    Article  CAS  PubMed  Google Scholar 

  5. Richardson S, Shaffer JA, Falzon L, Krupka D, Davidson KW, Edmondson D. Meta-analysis of perceived stress and its association with incident coronary heart disease. Am J Cardiol. 2012;110:1711–1716.

    Article  PubMed  PubMed Central  Google Scholar 

  6. McEwen BS, Gianaros PJ. Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease. Ann NY Acad Sci. 2010;1186:190.

    Article  PubMed  Google Scholar 

  7. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.

  8. Spruill TM. Chronic psychosocial stress and hypertension. Curr Hypertens Rep. 2010;12:10–16.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liu MY, Li N, Li WA, Khan H. Association between psychosocial stress and hypertension: a systematic review and meta-analysis. Neurol Res. 2017;39:573–80.

    Article  PubMed  Google Scholar 

  10. Lu X, Juon HS, He X, Dallal CM, Wang MQ, Lee S. The association between perceived stress and hypertension among asian americans: does social support and social network make a difference? J Community Health. 2019;44:451–62.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Spruill TM, Butler MJ, Thomas SJ, Tajeu GS, Kalinowski J, Castañeda SF, et al. Association between high perceived stress over time and incident hypertension in black adults: findings from the Jackson Heart Study. J Am Heart Assoc. 2019;8. https://doi.org/10.1161/JAHA.119.012139.

  12. Nabi H, Chastang J-F, Lefèvre T, Dugravot A, Melchior M, Marmot MG, et al. Trajectories of depressive episodes and hypertension over 24 years: the Whitehall II prospective cohort study. Hypertension. 2011;57:710–716.

    Article  CAS  PubMed  Google Scholar 

  13. Meng L, Chen D, Yang Y, Zheng Y, Hui R. Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. J Hypertens. 2012;30:842–51.

    Article  CAS  PubMed  Google Scholar 

  14. Sarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N, et al. The Isfahan cohort study: rationale, methods and main findings. J Hum Hypertens. 2011;25:545–53.

    Article  CAS  PubMed  Google Scholar 

  15. Nouri F, Feizi A, Mohammadifard N, Sarrafzadegan N. Methods of sampling and sample size determination of a comprehensive integrated community-based interventional trial: Isfahan Healthy Heart Program. ARYA Atheroscler. 2018;14:58.

    PubMed  PubMed Central  Google Scholar 

  16. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–71.

    Article  CAS  PubMed  Google Scholar 

  17. Pressure WG on R and HB. An epidemiological approach to describing risk associated with blood pressure levels. Hypertension. 1985;7:641–51.

    Article  Google Scholar 

  18. Goldberg D. General health questionnaire (GHQ-12) edn. UK: NFER-Nelson Wind; 1992.

  19. Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes. 2003;1:1–4.

    Article  Google Scholar 

  20. Roohafza H, Ramezani M, Sadeghi M, Shahnam M, Zolfagari B, Sarafzadegan N. Development and validation of the stressful life event questionnaire. Int J Public Health. 2011;56:441–448.

    Article  PubMed  Google Scholar 

  21. Wickramasinghe VP, Cleghorn GJ, Edmiston KA, Murphy AJ, Abbott RA, Davies PSW. Validity of BMI as a measure of obesity in Australian white Caucasian and Australian Sri Lankan children. Ann Hum Biol. 2005;32:60–71.

    Article  CAS  PubMed  Google Scholar 

  22. Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985;122:51–65.

    Article  CAS  PubMed  Google Scholar 

  23. Kennedy ET, Ohls J, Carlson S, Fleming K. The healthy eating index: design and applications. J Am Diet Assoc. 1995;95:1103–1108.

    Article  CAS  PubMed  Google Scholar 

  24. Haghighatdoost F, Sarrafzadegan N, Mohammadifard N, Sajjadi F, Maghroon M, Boshtam M, et al. Healthy eating index and cardiovascular risk factors among Iranians. J Am Coll Nutr. 2013;32:111–21.

    Article  CAS  PubMed  Google Scholar 

  25. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sport Exerc. 2003;35:1381–95.

    Article  Google Scholar 

  26. Talaei M, Rabiei K, Talaei Z, Amiri N, Zolfaghari B, Kabiri P, et al. Physical activity, sex, and socioeconomic status: a population based study. ARYA Atheroscler. 2013;9:51.

    PubMed  PubMed Central  Google Scholar 

  27. Pasquali R. The hypothalamic–pituitary–adrenal axis and sex hormones in chronic stress and obesity: pathophysiological and clinical aspects. Ann NY Acad Sci. 2012;1264:20.

    Article  CAS  PubMed  Google Scholar 

  28. Hamer M, Molloy GJ, Stamatakis E. Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms. J Am Coll Cardiol. 2008;52:2156–62.

    Article  PubMed  Google Scholar 

  29. Lambert EA, Lambert GW. Stress and its role in sympathetic nervous system activation in hypertension and the metabolic syndrome. Curr Hypertens Rep. 2011;13:244–248.

    Article  PubMed  Google Scholar 

  30. Singh JP, Larson MG, Tsuji H, Evans JC, O’Donnell CJ, Levy D. Reduced heart rate variability and new-onset hypertension: insights into pathogenesis of hypertension: the Framingham Heart Study. Hypertension. 1998;32:293–297.

    Article  CAS  PubMed  Google Scholar 

  31. Groeschel M, Braam B. Connecting chronic and recurrent stress to vascular dysfunction: no relaxed role for the renin-angiotensin system. Am J Physiol Physiol. 2011;300:F1–F10.

    Article  CAS  Google Scholar 

  32. Logan JG, Barksdale DJ, Carlson J, Carlson BW, Rowsey PJ. Psychological stress and arterial stiffness in Korean Americans. J Psychosom Res. 2012;73:53–58.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Winkleby MA, Ragland DR, Syme SL. Self-reported stressors and hypertension: evidence of an inverse association. Am J Epidemiol. 1988;127:124–34.

    Article  CAS  PubMed  Google Scholar 

  34. Heard E, Whitfield KE, Edwards CL, Bruce MA, Beech BM. Mediating effects of social support on the relationship among perceived stress, depression, and hypertension in African Americans. J Natl Med Assoc. 2011;103:116–22.

    PubMed  Google Scholar 

  35. Cabeza de Baca T, Burroughs Peña MS, Slopen N, Williams D, Buring J, Albert MA. Financial strain and ideal cardiovascular health in middle-aged and older women: Data from the Women’s health study. Am Heart J. 2019;215:129–38.

    Article  PubMed  Google Scholar 

  36. Karasek R, Baker D, Marxer F, Ahlbom A, Theorell T. Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men. Am J Public Health. 1981;71:694–705.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Markovitz JH, Matthews KA, Whooley M, Lewis CE, Greenlund KJ. Increases in job strain are associated with incident hypertension in the CARDIA Study. Ann Behav Med. 2004;28:4–9.

    Article  PubMed  Google Scholar 

  38. Guimont C, Brisson C, Dagenais GR, Milot A, Vézina M, Mâsse B, et al. Effects of job strain on blood pressure: a prospective study of male and female white-collar workers. Am J Public Health. 2006;96:1436–43.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Tomei G, Fioravanti M, Cerratti D, Sancini A, Tomao E, Rosati MV, et al. Occupational exposure to noise and the cardiovascular system: a meta-analysis. Sci Total Environ. 2010;408:681–689.

    Article  CAS  PubMed  Google Scholar 

  40. Porba R, Poroba M, Gac P, Andrzejak R. Ambulatory blood pressure monitoring and structural changes in carotid arteries in normotensive workers occupationally exposed to lead. Hum Exp Toxicol. 2011;30:1174.

    Article  CAS  Google Scholar 

  41. Siegrist J, Rödel A. Work stress and health risk behavior. Scand J Work Environ Health. 2006;32:473–81.

  42. Matthews KA, Kiefe CI, Lewis CE, Liu K, Sidney S, Yunis C. Socioeconomic trajectories and incident hypertension in a biracial cohort of young adults. Hypertension. 2002;39:772–776.

    Article  CAS  PubMed  Google Scholar 

  43. Steptoe A, Brydon L, Kunz-Ebrecht S. Changes in financial strain over three years, ambulatory blood pressure, and cortisol responses to awakening. Psychosom Med. 2005;67:281–287.

    Article  PubMed  Google Scholar 

  44. Wilkinson RG. Socioeconomic determinants of health: health inequalities: relative or absolute material standards? BMJ. 1997;314:591.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Wilkinson RG, Pickett KE. Income inequality and population health: a review and explanation of the evidence. Soc Sci Med. 2006;62:1768–84.

    Article  PubMed  Google Scholar 

  46. Steptoe A, Marmot M. Psychosocial, hemostatic, and inflammatory correlates of delayed poststress blood pressure recovery. Psychosom Med. 2006;68:531–537.

    Article  PubMed  Google Scholar 

  47. Redondo-Sendino Á, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. Relationship between social network and hypertension in older people in Spain. Rev Española Cardiol. 2005;58:1294–301.

    Article  Google Scholar 

  48. Hurlbert DF, Apt C, Rabehl SM. Key variables to understanding female sexual satisfaction: an examination of women in nondistressed marriages. J Sex Marital Ther. 1993;19:154–65.

    Article  CAS  PubMed  Google Scholar 

  49. Bodenmann G, Atkins DC, Schär M, Poffet V. The association between daily stress and sexual activity. J Fam Psychol. 2010;24:271.

    Article  PubMed  Google Scholar 

  50. Nealey-Moore JB, Smith TW, Uchino BN, Hawkins MW, Olson-Cerny C. Cardiovascular reactivity during positive and negative marital interactions. J Behav Med. 2007;30:505–19.

    Article  PubMed  Google Scholar 

  51. Grewen KM, Girdler SS, Light KC. Relationship quality: effects on ambulatory blood pressure and negative affect in a biracial sample of men and women. Blood Press Monit. 2005;10:117–24.

    Article  PubMed  Google Scholar 

  52. Geller PA. Pregnancy as a stressful life event. CNS Spectr. 2004;9:188–97.

    Article  PubMed  Google Scholar 

  53. Pais M, Pai MV. Stress among pregnant women: a systematic review. J Clin Diagn Res. 2018;12:LE01–4.

  54. Wiwanitkit V. Traffic noise, toxin, emotional stress: how to control? Noise Health. 2010;12:283.

    Article  PubMed  Google Scholar 

  55. Babisch W, Wolf K, Petz M, Heinrich J, Cyrys J, Peters A. Associations between traffic noise, particulate air pollution, hypertension, and isolated systolic hypertension in adults. KORA Study. 2014;492:492–498.

    Google Scholar 

  56. Lee E-S, Park S. Patterns of change in employment status and their association with self-rated health, perceived daily stress, and sleep among young adults in South Korea. Int J Environ Res Public Health. 2019;16:4491.

    Article  PubMed Central  Google Scholar 

  57. Huang Y, Mai W, Hu Y, Wu Y, Song Y, Qiu R, et al. Poor sleep quality, stress status, and sympathetic nervous system activation in nondipping hypertension. Blood Press Monit. 2011;16:117–23.

    Article  PubMed  Google Scholar 

  58. Palagini L, Bruno RM, Cheng P, Mauri M, Taddei S, Ghiadoni L, et al. Relationship between insomnia symptoms, perceived stress and coping strategies in subjects with arterial hypertension: Psychological factors may play a modulating role. Sleep Med. 2016;19:108–15.

    Article  PubMed  Google Scholar 

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Acknowledgements

This cohort study was conducted by the Cardiovascular Research Institute affiliated with the Isfahan University of Medical Sciences (research number 84119). The authors thank the staff and participants of the ICS cohort study. This article was derived from a thesis at the Isfahan University of Medical Sciences (No. 399913).

Funding

The Iranian Budget and Planning Organization provided a grant [Grant No. 31309304] for the baseline study.

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Authors and Affiliations

  1. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

    Hamidreza Roohafza & Nizal Sarrafzadegan

  2. Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

    Niloofar Sattari

  3. Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

    Fatemeh Nouri

  4. Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

    Mohammad Talaei

  5. Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

    Gholamreza Masoumi

  6. Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

    Masoumeh Sadeghi

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  1. Hamidreza Roohafza
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Correspondence to Masoumeh Sadeghi.

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Roohafza, H., Sattari, N., Nouri, F. et al. Do any kinds of perceived stressors lead to hypertension? A longitudinal cohort study. Hypertens Res 45, 1058–1066 (2022). https://doi.org/10.1038/s41440-022-00895-3

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