In a study that included over 400 adults with normal BP, it was detected that those who had high levels of stress hormones—their urine was more likely to develop high BP over the next six to seven years. The findings of the study were published in the journal ‘Hypertension’. Higher levels of the stress hormone cortisol were also linked to an increased risk of cardiovascular events including heart attack and stroke.
Studies have shown that cumulative exposure to daily stressors and exposure to traumatic stress can increase cardiovascular disease risk. A growing body of research refers to the mind-heart-body connection, which suggests a person’s mind can positively or negatively affect cardiovascular health, risk factors and risk of disease events, and prognosis over time.
“The stress hormones norepinephrine, epinephrine, dopamine, and cortisol can increase with stress from life events, work, relationships, finances, and more. And we confirmed that stress is a key factor contributing to the risk of hypertension and cardiovascular events,” said study author Kosuke Inoue, MD, PhD, assistant professor of social epidemiology at Kyoto University in Kyoto, Japan. “Previous research focused on the relationship between stress hormone levels and hypertension or cardiovascular events in patients with existing hypertension. However, studies looking at adults without hypertension were lacking,” Inoue said. “It is crucial to examine the impact of stress on adults in the general population as it provides new information about whether routine measurement of stress hormones needs to be considered to prevent hypertension and CVD events,” he added.
Study subjects were part of the MESA Stress 1 study, a substudy of the Multi-Ethnic Study of Atherosclerosis (MESA), a large study of atherosclerosis risk factors among over 6,000 men and women from six US communities. As part of MESA exams 3 and 4 (conducted between July 2004 and October 2006), White, Black and Hispanic participants with normal BP from the New York and Los Angeles sites were invited to participate in the substudy MESA Stress 1. In this substudy, researchers analysed levels of norepinephrine, epinephrine, dopamine, and cortisol hormones that respond to stress levels. Hormone levels were measured in a 12-hour overnight urine test. The substudy included 412 adults aged between 48-87 years. About half of them were female, 54% were Hispanic, 22% were Black, and 24% were White. Participants were followed for three more visits (between September 2005 and June 2018) for the development of hypertension and cardiovascular events.
Norepinephrine, epinephrine, and dopamine are molecules known as catecholamines that maintain stability throughout the autonomic nervous system—the system that regulates involuntary body functions. Cortisol is a steroid hormone released when one experiences stress and is regulated by the hypothalamic-pituitary-adrenal axis, which modulates the stress response. “Although all of these hormones are produced in the adrenal gland, they have different roles and mechanisms to influence the cardiovascular system so it is crucial to study their relationship with hypertension and cardiovascular events, individually,” Inoue said. Their analysis of the relationship between stress hormones and the development of atherosclerosis found that over a median of the 6.5-years follow-up period, every time the levels of the four stress hormones doubled was associated with a 21%-31% increase in the risk of developing hypertension. During a median of 11.2-years of follow-up, there was a 90% increased risk of cardiovascular events with each doubling of cortisol levels. There was no association between cardiovascular events and catecholamines.
“It is challenging to study psychosocial stress since it is personal and its impact varies for each individual. We used a noninvasive measure, a single urine test, to determine whether such stress might help identify people in need of additional screening to prevent hypertension and possibly cardiovascular events,” Inoue said. “The next key research question is whether and in which populations increased testing of stress hormones could be helpful. Currently, these hormones are measured only when hypertension with an underlying cause or other related diseases are suspected,” he continued. “But if additional screening could help prevent hypertension and cardiovascular events, we may want to measure these hormone levels more frequently,” Inoue added.
A limitation of the study is it didn’t include people who had hypertension at the study’s start, which would have resulted in a larger study population. Another limitation is researchers measured stress hormones via a urine test only, and no other tests for stress hormone measurement were used.