It is well established that acute stress (like getting a fright, or having a fight with someone, or hearing bad news) can increase your blood pressure. I see this regularly when my patients come to see me, and their blood pressure is initially elevated. When I recheck it after a few minutes or at the end of the examination, it has usually settled significantly. We call this “white-coat syndrome”, where the anxiety of seeing a doctor temporarily raises the blood pressure. But there is some suggestion that chronic exposure to stress may also contribute to more consistently elevated blood pressure. Here is an article from the Wisconsin Medical Journal in 1998 which discussed this concept.
ALSO READ : Turning the Tide – Dealing with the scourge of hypertension (Part 6)
But the basis for this article today is found in another comprehensive article from the journal Current Hypertensive Reports in 2010, by Tanya M Spruill . I will provide a summary of this very detailed article.
We are psychosocial beings – life around us affects our behaviour and physiological responses. If that environment is highly stressful, it is obvious that we react to it, and that reaction affects our health. This is a more difficult area to study than empirical data, because it relies upon feelings and varying differences in response. So much is dependent upon our upbringing and our personalities; our past experiences and parental influences. But it is the intensity and duration of stressful influences that most often affect blood pressure.
Occupational stress:
We all recognise that certain jobs come with great stress. This is particularly relevant when there is high demand, but little control or choice over how we accomplish these, e.g. meeting targets that you were not involved in formulating. Studies have shown that this type of stress increases blood pressure not only at work, but even after work and during sleep. The longer the exposure to these stresses, the greater the risk of chronic blood pressure elevation. Men are more likely to develop high blood pressure in these circumstances than women. Examples of this type of work stress include Air Traffic controllers, Doctors, Nurses, investors in the Stock Exchange, Teachers dealing with large unruly classes, etc.
Social isolation and marital stress:
“Social relationships are important sources of emotional and practical support and can buffer the negative physical and psychological effects of stress. The lack of supportive relationships not only leaves one without these resources, but can itself be a major source of stress.” We are social creatures, and isolation and lack of community support have many health ramifications. Studies have confirmed that many diseases are more common amongst singles, or where support structures have crumbled through death or separation (children moving away from home, emigration, etc.).
Marriage can be an important supportive relationship, but we also know that it can be a huge source of conflict and strain. Studies have been done on couples during happy interactions, neutral interactions and conflict interactions. Blood pressure is elevated during the conflict, but the elevated blood pressure persists for long after the episode of conflict. Long term effect on blood pressure from marital conflict seems to affect women more than men.
Low socioeconomic status:
Financial strain, battling to make ends meet, unpaid bills, providing enough food and clothing for the family, job insecurity, medical care unavailability, uncertainty of the future – all are related to income and life situations.
And these all can impact upon general health and in particular blood pressure.
Socio-economic factors often influence the type of neighbourhood where one is forced to live, and that can bring its own set of problems – lack of security, violence, transport issues, education opportunities for the children, etc.
Racial discrimination:
“African Americans living in the United States suffer from disproportionately higher rates of hypertension than whites, and the reasons for this disparity remain poorly understood. In addition to socioeconomic differences, exposure to racial discrimination has been proposed as a contributing factor. Discrimination includes negative attitudes and beliefs about members of ethnic or racial minority groups, as well as differential treatment. It encompasses both explicit and more subtle behaviour such as unfair treatment, stigmatisation, social exclusion, and overt acts of verbal or physical aggression, and can occur at the interpersonal, institutional, and cultural levels.” It seems that racial discrimination has very deep emotional consequences that strongly affect our physiology.
Mechanisms Underlying the Stress-Hypertension Relationship:
“The impact of stress on the development of hypertension is believed to involve a sympathetic nervous system response, in which release of catecholamines (like adrenalin and nor-adrenalin) leads to increased heart rate, cardiac output, and BP. Sympathetic responses to acute stress are well documented, but the process by which stress contributes to sustained BP elevation over time is not well understood. It may be repeated activation of this system, failure to return to resting levels following stressful events, failure to habituate to repeated stressors of the same type, or some combination that is responsible for the development of hypertension.”
Recent research has shown that certain individuals have a much more prolonged response to stressful events. Those who take longer to recover are more likely to end up with chronic high blood pressure.
“Rumination is the name given to persistent mulling over stresses – repetitive, intrusive, negative thoughts – that has been proposed as a mechanism that may delay BP recovery. Stressful events often lead to negative moods, including depression, anxiety, and anger, and to negative thoughts about the events, which, according to this hypothesis, can sustain physiological arousal. Stress-related emotions and thoughts are not limited to those occasions when a stressor is actually present; a substantial amount of time may also be spent in anticipation of future stress and dealing with past stress. For example, teachers reporting high job strain engaged in more ruminative thoughts about work in the evening than teachers reporting low job strain, even after controlling for time spent working at home. If rumination does in fact sustain stress-related physiological arousal, this may help to explain the observed carryover effects of job strain on BP outside the work setting.”
Conclusions:
Stress factors seem to be important in the development of chronic stress, but this effect varies between individuals – various factors are present – gender, race, socio-economic level, etc. An important concept is that of rumination – persistent negative thoughts, which cause the stress hormones to continue affecting physiology for long after the actual stressful event has abated.
Various interventions have been tried to combat stress sufficient to elicit high blood pressure – things like biofeedback, progressive muscle relaxation, stress management training and meditation.
Interestingly only meditation was statistically significantly effective at reducing blood pressure by reducing rumination.
The following is a helpful summary of interventions to reduce stress and keep blood pressure down, produced by Harvard Health Publishing.
- Get enough sleep. Inadequate or poor-quality sleep can negatively affect your mood, mental alertness, energy level, and physical health.
- Learn relaxation techniques. Meditation, progressive muscle relaxation, guided imagery, deep breathing exercises, and yoga are powerful relaxation techniques and stress-busters. (Spirituality, prayer and church attendance have been shown to reduce blood pressure.) *
- Strengthen your social network. Connect with others by taking a class, joining an organisation, or participating in a support group. (Joining clubs, finding a church to join, spending time rekindling family relationships are all helpful.) *
- Hone your time-management skills. The more efficiently you can juggle work and family demands, the lower your stress level.
- Try to resolve stressful situations if you can. Don’t let stressful situations fester. Hold family problem-solving sessions and use negotiation skills at home and at work.
- Nurture yourself. Treat yourself to a massage. Truly savour an experience: for example, eat slowly and really focus on the taste and sensations of each bite. Take a walk or a nap, or listen to your favourite music.
- Ask for help. Don’t be afraid to ask for help from your spouse, friends, and neighbours. If stress and anxiety persist, talk to your doctor.
(* Interventions in brackets are comments I have attached that were not in the original document. DG).
Along with these ways to reduce stress, add in a healthy lifestyle — maintaining a healthy weight, not smoking, regular exercise, and a diet that includes fruits, vegetables, whole grains, lean protein, and healthful fats — and high blood pressure could be a thing of the past.
Next week we will delve more deeply into some of the practical ways of dealing with stress and its effect upon our health and well-being.
To a week ahead where we learn to control stress and its effect upon our blood pressure.
Dave Glass
Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.
He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.
An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.
He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.
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