STRESS, CORTISOL, AND HYPERTENSION: UNVEILING THE LINK AND IMPLICATIONS FOR CARDIOVASCULAR HEALTH
Main Article Content
Keywords
Stress, depression, anxiety, cortisol, hypertension, CVDs
Abstract
Background: Cortisol, a stress hormone originating from the adrenal cortex's zona fasciculata, is known to exert its effects on the central nervous system, particularly in regions that regulate blood pressure. Cortisol reactivity, an indicator of hypothalamic-pituitary-adrenal function, is a potential mechanism through which psychosocial stress may impact the risk of developing hypertension.
Objectives and Methods: This study explored the association between stress and hypertension by assessing psychological stress levels using the Depression, Anxiety, and Stress Scale (DASS) and measuring physiological stress through cortisol release using Radioimmunoassay (RIA) systems.
Results: Our findings revealed that hypertensive patients exhibited significantly higher levels of psychological stress as measured by the DASS and elevated cortisol levels compared to control subjects. Additionally, we observed a significant correlation between depression, anxiety, stress, and cortisol levels within the patient group. Notably, a noteworthy association existed between depression, stress, and increased cortisol release.
Conclusion: The current study's findings elucidated a significant association between heightened depressive symptoms and psychological stress and an upregulated cortisol secretion. This intricate relationship underscores the potential contribution of cortisol dysregulation to the etiology of hypertension and associated cardiovascular disorders.
References
2. Mushtaq, M.; Najam, N. Depression, anxiety, stress and demographic determinants of hypertension disease. Pakistan journal of medical sciences 2014, 30, 1293.
3. Association, A.P. Stress: The different kinds of stress. Retrieved from American Psychological Association website: http://www. apa. org/helpcenter/stress-kinds. aspx 2011.
4. Wei, J.; Rooks, C.; Ramadan, R.; Shah, A.J.; Bremner, J.D.; Quyyumi, A.A.; Kutner, M.; Vaccarino,V. Meta-analysis of mental stress–induced myocardial ischemia and subsequent cardiac events in patients with coronary artery disease. The American journal of cardiology 2014, 114, 187-192.
5. Baum, A.; Grunberg, N. Measurement of stress hormones. Measuring stress: A guide for health and social scientists 1995, 175-192.
6. Barton, B.A. Stress in fishes: A diversity of responses with particular reference to changes in circulating corticosteroids. Integrative and comparative biology 2002, 42, 517-525.
7. VanItallie, T.B. Stress: A risk factor for serious illness. Metabolism-Clinical and Experimental 2002, 51, 40-45.
8. Kelly, J.; Mangos, G.; Williamson, P.; Whitworth, J. Cortisol and hypertension. Clinical and Experimental Pharmacology and Physiology 1998, 25, S51-S56.
9. Miller, M.A.; Cappuccio, F.P. Inflammation, sleep, obesity and cardiovascular disease. Current vascular pharmacology 2007, 5, 93-102.
10. Markovitz, J.H.; Matthews, K.A.; Kannel, W.B.; Cobb, J.L.; D'Agostino, R.B. Psychological predictors of hypertension in the framingham study: Is there tension in hypertension? Jama 1993, 270, 2439-2443.
11. Gerin, W.; Davidson, K.W.; Christenfeld, N.J.; Goyal, T.; Schwartz, J.E. The role of angry rumination and distraction in blood pressure recovery from emotional arousal. Psychosomatic medicine 2006, 68, 64-72.
12. Oswald, L.M.; Zandi, P.; Nestadt, G.; Potash, J.B.; Kalaydjian, A.E.; Wand, G.S. Relationship between cortisol responses to stress and personality. Neuropsychopharmacology 2006, 31, 1583-1591.
13. Vedhara, K.; Miles, J.; Bennett, P.; Plummer, S.; Tallon, D.; Brooks, E.; Gale, L.; Munnoch, K.; Schreiber-Kounine, C.; Fowler, C. An investigation into the relationship between salivary cortisol, stress, anxiety and depression. Biological psychology 2003, 62, 89-96.
14. Shea, A.K.; Streiner, D.L.; Fleming, A.; Kamath, M.V.; Broad, K.; Steiner, M. The effect of depression, anxiety and early life trauma on the cortisol awakening response during pregnancy: Preliminary results. Psychoneuroendocrinology 2007, 32, 1013-1020.
15. James, K.A.; Stromin, J.I.; Steenkamp, N.; Combrinck, M.I. Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Frontiers in Endocrinology 2023, 14, 1085950.
16. Shah, S.; Luby, S.; Rahbar, M.; Khan, A.; McCormick, J. Hypertension and its determinants among adults in high mountain villages of the northern areas of pakistan. Journal of human hypertension 2001, 15, 107-112.
17. Walker, B.R.; Stewart, P.M.; Padfield, P.L.; Edwards, C.R. 8 increased vasoconstriction to glucocorticoids in essential hypertension: 11β-hydroxysteroid dehydrogenase deficiency revisited. Journal of Hypertension 1991, 9, 1082.
18. Soro, A.; Ingram, M.C.; Tonolo, G.; Glorioso, N.; Fraser, R. Evidence of coexisting changes in 11β- hydroxysteroid dehydrogenase and 5β-reductase activity in subjects with untreated essential hypertension. Hypertension 1995, 25, 67-70.
19. Mangos, G.; Kelly, J.; Whitworth, J. Cortisol and essential hypertension. 2000.
20. Whitworth, J.A.; Williamson, P.M.; Mangos, G.; Kelly, J.J. Cardiovascular consequences of cortisol excess. Vascular health and risk management 2005, 1, 291-299.
21. Nakanishi, N.; Yoshida, H.; Nagano, K.; Kawashimo, H.; Nakamura, K.; Tatara, K. Long working hours and risk for hypertension in japanese male white collar workers. Journal of Epidemiology & Community Health 2001, 55, 316-322.
22. Jonas, B.S.; Franks, P.; Ingram, D.D. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the national health and nutrition examination survey i epidemiologic follow-up study. Archives of family medicine 1997, 6, 43-49.
23. Goiato, M.C.; Da Silva, E.V.F.; Cândido, N.B.; Nóbrega, A.S.; De Medeiros, R.A.; Sumida, D.H.; Chiba, F.Y.; Dos Santos, D.M. Evaluation of the level of cortisol, capillary blood glucose, and blood pressure in response to anxiety of patients rehabilitated with complete dentures. BMC Oral Health 2019, 19, 1-7.
24. Hildrum, B.; Mykletun, A.; Holmen, J.; Dahl, A.A. Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. The British Journal of Psychiatry 2008, 193, 108- 113.
25. Piccirillo, G.; Bucca, C.; Tarantini, S.; Santagada, E.; Viola, E.; Durante, M.; Raganato, P.; Mariano, A.; Cacciafesta, M.; Marigliamo, V. Sympathetic activity and anxiety in hypertensive and normotensive subjects. Archives of gerontology and geriatrics 1998, 26, 399-406.
26. Romero, C.A.; Orias, M.; Weir, M.R. Novel raas agonists and antagonists: Clinical applications and controversies. Nature Reviews Endocrinology 2015, 11, 242-252.
27. Amar, L.; Azizi, M.; Menard, J.; Peyrard, S.; Watson, C.; Plouin, P.-F. Aldosterone synthase inhibition with lci699: A proof-of-concept study in patients with primary aldosteronism. Hypertension 2010, 56, 831-838.
28. Andersen, K.; Hartman, D.; Peppard, T.; Hermann, D.; Van Ess, P.; Lefkowitz, M.; Trapani, A. The effects of aldosterone synthase inhibition on aldosterone and cortisol in patients with hypertension: A phase ii, randomized, double‐blind, placebo‐controlled, multicenter study. The Journal of Clinical Hypertension 2012, 14, 580-587.
29. Stauss, H.M. Identification of blood pressure control mechanisms by power spectral analysis. Clinical and experimental pharmacology and physiology 2007, 34, 362-368.
30. Akselrod, S.; Gordon, D.; Ubel, F.A.; Shannon, D.C.; Berger, A.C.; Cohen, R.J. Power spectrum analysis of heart rate fluctuation: A quantitative probe of beat-to-beat cardiovascular control. science 1981, 213, 220-222.
31. Ponchon, P.; Elghozi, J. Contribution of humoral systems to the short-term variability of blood pressure after severe hemorrhage. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 1997, 273, R58-R69.
32. Ponchon, P.; Grichois, M.-L.; Elghozi, J.-L. Effect of losartan on short-term variability of blood pressure of renovascular hypertensive rats: A spectral study. Journal of Hypertension 1993, 11, S244-S245.
33. Dutrey-Dupagne, C.; Girard, A.; Ulmann, A.; Elghozi, J.-L. Effects of the converting enzyme inhibitor trandolapril on short-term variability of blood pressure in essential hypertension. Clinical Autonomic Research 1991, 1, 303-307.
34. Blanc, J.; Lambert, G.; Elghozi, J.-L. Endogenous renin and related short-term blood pressure variability in the conscious rat. European journal of pharmacology 2000, 394, 311-320.
35. Ponchon, P.; Elghozi, J.L. Contribution of the renin-angiotensin and kallikrein-kinin systems to short-term variability of blood pressure in two-kidney, one-clip hypertensive rats. European journal of pharmacology 1996, 297, 61-70.
36. Janssen, B.J.; Tyssen, C.M.; Struyker-Boudier, H.A. Modification of circadian blood pressure and heart rate variability by five different antihypertensive agents in spontaneously hypertensive rats. Journal of cardiovascular pharmacology 1991, 17, 494-503.
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Shiza Unab
Department of Zoology, University of Mianwali, Mianwali 42200, Pakistan
Maleeha Akram
Department of Zoology, Wildlife and Fisheries, Pir Meher Ali Shah Arid Agriculture University, Rwalpindi, 46300, Pakistan.
Shanza Ahmad
Department of Zoology, Wildlife and Fisheries, Pir Meher Ali Shah Arid Agriculture University, Rwalpindi, 46300, Pakistan.
Bushra Moon
School of Life Sciences, Hainan Normal University, China
Raniya Saleem
Department of Microbiology, University of Swabi, KPK, Pakistan
Mazhar Qayyum
Department of Zoology, Wildlife and Fisheries, Pir Meher Ali Shah Arid Agriculture University, Rwalpindi, 46300, Pakistan.
Syed Shakeel Raza Rizvi
Department of Zoology, Wildlife and Fisheries, Pir Meher Ali Shah Arid Agriculture University, Rwalpindi, 46300, Pakistan.