Stress and Hypertension Studies

Decades and billions of dollars later, the mind/body research has led to these conclusions:

1. The emotional stress and distress we experience daily does briefly raise blood pressure in everyone.
2. Emotional stress and distress do not result in sustained blood pressure elevation (hypertension)
3. Relaxation techniques briefly lower our blood pressure, but also have no lasting effects.

This mind/body research was conducted mainly by research psychologists who strongly believed in the traditional mind/body concept that stress causes hypertension but failed to confirm any relationship between hypertension and measured levels of emotional distress, such as anger, anxiety, and depression.

The quality of these studies varied considerably. As a result, reviews and meta-analyses of the studies that have been reported conclude that the stress, anger, and anxiety that we experience and report are not significant causes of hypertension.

The most reliable studies involved sustained blood pressure monitoring over a 24-hour period.

In this setting, the results most reassembled american life, including all the stress we experience daily. These studies further confirmed the lack of a relationship between emotional distress and hypertension. While the test subjects' blood pressure does fluctuate throughout the day, there are no long-term effects of being subjected to life’s stressors.

My decades of clinical experience agree with these results. I’ve followed the blood pressure of many patients during periods of severe stress in their lives. While their blood pressure may temporarily increase, it eventually falls back into a normal range and does not directly lead to persisting hypertension.

Work Stress

If stress caused hypertension, then we could expect work stress to be a prominent cause, since we spend most of our lives at work.

The fact is, in most studies, the stress/hypertension relationship isn’t found. You can find more about these studies in a review I published in 2006. Many of the studies were of limited quality. The most methodologically sound study measured job stress and 24-hour blood pressure, then reassessed the 24-hour blood pressure five years later. It reported no relationship—not a single millimeter, between job stress and change in blood pressure from its baseline level.

The Stress to Hypertension Myth

If stress doesn't cause hypertension then why do so many people, including medical professionals, think it does? There are a few reasons for this misconception.

1. It is true that anxiety does raise blood pressure temporarily. This is a normal and necessary physiologic response to acute stress, our “fight or flight response.” But the effect is not sustained.
2. Anxiety often increases blood pressure at the doctor’s office (“white coat” hypertension), with normal readings outside the doctor’s office. The anxiety didn’t cause hypertension; the patient didn’t have hypertension.
3. Studies failed to confirm that stress is a direct cause of hypertension but it can be an indirect cause through its effects on habits such as overeating, smoking, alcohol abuse, and other poor lifestyle choices.

So while stress doesn't cause prolonged hypertension, it plays a role in temporary increases in blood pressure and habits that are formed, good or bad.

Against Conventional Wisdom

In most patients, hypertension is a result of physiologic factors, such as salt-sensitive hypertension, and enzymes and hormones that cause vasoconstriction.

For about 10% of patients, their hypertension is a result of a mind/body cause. And it’s often related to the surprising absence of emotion! 

More specifically, it is related to repressed emotions, which are emotions we’ve subconsciously blocked from our awareness. These powerful emotions are often related to a history of severe or prolonged stress, or trauma, that we have endured.

The ability to repress and be unaware of powerful emotions is a gift. In many cases, it is a crucial component of our emotional resilience. The ability to not feel when we need to keep going.

Without realizing it, we repress potentially overwhelming emotions when we need to, and move on. But unknown to physicians and patients alike, those powerful emotions persist within us, hidden from our awareness, and affect us physiologically.

They can cause or contribute to hypertension and many other chronic medical conditions.  Despite decades of research, these chronic illnesses still remain partially or completely a mystery.

In my recent book, Hidden Within Us; a Radical New Understanding of the Mind-Body Connection, I dive deep into this understanding that does not yet exist in Medicine, but offers a new path to understanding the mind/body connection, and offers new pathways to the treatment and healing of medical disorders.

To sum this all up, NO, everyday stress does not cause or contribute to prolonged high blood pressure (hypertension) on its own.

YES, stress does contribute to other activities like overeating, excessive alcohol consumption, and other poor lifestyle choices, which in turn can result in hypertension.

In 10% of hypertension diagnoses, repressed emotions are the primary cause. In other cases, repressed emotion may be a secondary cause of hypertension.

If you are taking diuretics and notice that you are still experiencing regular high blood pressure readings, I suggest reading 3 Reasons Why the Diuretics You Are Taking Are Not Controlling Your Blood Pressure.