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Chronic mental stress is a cause of essential hypertension : presence of biological markers of stress

journal contribution
posted on 2008-04-01, 00:00 authored by M Esler, N Eikelis, M Schlaich, G Lambert, M Alvarenga, T Dawood, D Kaye, D Barton, Ciaran Pier, L Guo, C Brenchley, G Jennings, E Lambert
1. In searching for biological evidence that essential hypertension is caused by chronic mental stress, a disputed proposition, parallels are noted with panic disorder, which provides an explicit clinical model of recurring stress responses.
2. There is clinical comorbidity; panic disorder prevalence is increased threefold in essential hypertension. Plasma cortisol is elevated in both.
3. In panic disorder and essential hypertension, but not in health, single sympathetic nerve fibres commonly fire repeatedly within an individual cardiac cycle; this appears to be a signature of stress exposure. For both conditions, adrenaline cotransmission is present in sympathetic nerves.
4. Tissue nerve growth factor is increased in both (nerve growth factor is a stress reactant). There is induction of the adrenaline synthesizing enzyme, phenylethanolamine-N-methyltransferase, in sympathetic nerves, an explicit indicator of mental stress exposure.
5. The question of whether chronic mental stress causes high blood pressure, still hotly debated, has been reviewed by an Australian Government body, the Specialist Medical Review Council. Despite the challenging medicolegal implications, the Council determined that stress is one proven cause of hypertension, this ruling being published in the 27 March 2002 Australian Government Gazette. This judgement was reached after consideration of the epidemiological evidence, but in particular after review of the specific elements of the neural pathophysiology of essential hypertension, described above.

History

Journal

Clinical and experimental pharmacology & physiology

Volume

35

Issue

4

Pagination

498 - 502

Publisher

Wiley-Blackwell Publishing Asia

Location

Carlton, Vic.

ISSN

0305-1870

eISSN

1440-1681

Language

eng

Publication classification

C1.1 Refereed article in a scholarly journal

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