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Low stress resilience in early life associated with later hypertension

Interventions to prevent hypertension later in life should address psychosocial and stress-related factors in late adolescence, particularly among patients with high BMI, according to researchers at Lund University, in Sweden, and Stanford University.

In a national cohort study published in Heart, the researchers concluded that low stress resilience may contribute to etiological pathways for hypertension, and account for more cases among those with high BMI. They added that, if confirmed, such a connection may help shape preventative interventions through better understanding of psychosocial risk factors and stress management.

“Substantial evidence has shown that psychosocial factors also contribute to the development of hypertension,” Casey Crump, MD, PhD, of the Stanford University department of medicine, in California, and colleagues wrote. … “However, to our knowledge, no studies have examined psychological assessment of stress resilience early in life in relation to hypertension risk in adulthood.”

To examine stress resilience in late adolescence in relation to hypertension risk in adulthood, the researchers conducted a national cohort study of 1,547,182 military conscripts in Sweden during 1969 to 1997. The conscripts in the cohort were 97% to 98% 18-year-old men without prior history of hypertension.

Researchers obtained stress resilience assessments from the Swedish Military Conscription Registry containing data from a 2-day standardized physical and psychological examination administered each year to all military conscripts. Among other traits, the test examined conscripts’ stress resilience in armed combat, scoring them on a 1-to-9 scale. Hypertension was identified from outpatient and inpatient diagnoses between 1969 and 2012.

According to the researchers, 93,028 men were diagnosed with hypertension in 39.4 million person-years of follow-up. After adjusting for BMI, family history and socioeconomic factors, low stress resilience at age 18 was associated with increased risk for hypertension in adulthood (lowest vs. highest quintile: HR = 1.43; 95% CI, 1.4-1.46; incidence rates, 278.7 vs 180 per 100,000 person-years). The results included “a strong linear trend across the full range of stress resilience” (P < .0001), according to the researchers. The researcher also observed “a positive additive interaction between stress resilience and BMI” (P < .001). Men with both low stress resistance and high BMI had a more than threefold risk for hypertension.

“The present study provides further evidence that interventions to prevent hypertension should address psychosocial and stress related factors,” Crump and colleagues wrote. … “Most stress reduction programs have focused on treatment rather than prevention of hypertension, with mixed results.” – by Jason Laday