Stress spikes BP levels in hypertensive adults

In adults with hypertension, highly stressful situations or emotions lead to an increase in blood pressure (BP), according to a recent study. Using a wearable BP monitoring device can help detect these BP spikes.

Fifty hypertensive adults (mean age 60.5 years, 92.0 percent men) had a mean seated systolic (SBP)/diastolic (DBP) BP of 113.1/81.3 mm Hg, while the average pulse rate was 71.4 bpm. When measured while the participants were feeling angry, SBP increased by a mean of 9.8 mm Hg. [Hypertens Res 2022;45:1531-1537]

Similarly, experiencing other emotions of distress raised SBP. Measurements were higher by 4.6 mm Hg when patients were feeling tense, by 4.2 mm Hg when feeling anxious, and by 11.1 mm Hg when feeling sad. In contrast, SBP eased by 2.4 mm Hg when measured while participants were feeling calm.

Due to large variations in BP datapoints per emotion, the researchers grouped emotions into three broad emotional states: positive, including happy and calm; negative, such as anxious, sad, and tense; and others, encompassing surprised and tired. Mean SBP was higher by 8.4 mm Hg when measured during negative vs positive emotions (p<0.001).

Moreover, SBP under moderate stress increased by 6.8 mm Hg and by 13.1 mm Hg when participants were under high stress (p<0.001 for both). Of note, SBP also spiked when measured during meetings (by 8.1 mmHg; p<0.001) and when patients were performing mild (by 3.2 mm Hg; p=0.002) or moderate (by 6.2 mm Hg; p<0.001) physical activity.

Pulse rate did not vary according to emotional factors, stress intensity, or location of measurement.

“This study investigated psychological stress-induced changes in BP during daily life as measured by a wearable watch-type oscillometric device for multiple days in working hypertensive patients,” the researchers said.

“We found that self-measured wearable BP increased during the experience of negative emotions, and the amplitude of the increase was even greater when accompanied by high stress,” they added.

Compounding effects on BP

Mixed-effects modelling further showed that aside from a patient’s emotional state, their location and degree of stress also significantly and strongly influenced changes in SBP.

For example, while negative emotions already correlated with a 5.0-mm Hg increase in SBP, this further jumped by 4.5–10.2 mm Hg when participants were feeling stressed. Those with both negative emotions and high stress saw a 15.2-mm Hg rise in SBP, while patients harbouring negative emotions but low stress only saw a 9.5-mm Hg increase (p<0.001 for all).

These findings were true for DBP, as well. During negative emotions, DBP significantly increased by 2.0 mm Hg (p=0.018). Under moderate and high stress, measurements jumped by 2.5 (p<0.001) and 4.7 (p=0.011) mm Hg, respectively. Unlike SBP, location emerged as an important determinant for DBP, which was higher by 1.8 mm Hg when measured at the patients’ worksite (p=0.002).

“The stress-induced BP increase was affected not only by negative mood but also by the stress intensity. Specifically, its amplitude was larger under stress of higher intensity,” the researchers said.

“Further research will be needed to confirm that these results can be replicated in a larger population,” they added, noting that future efforts are also needed to identify the clinical implications of stress-induced high BP.