Cortisol responses to mental stress and incident hypertension in healthy men and women.

CONTEXT: Heightened cardiovascular responses to mental stressors are associated with future risk of hypertension. The role of cortisol, a key stress hormone produced by the hypothalamic-pituitary-adrenal axis, remains unclear.

OBJECTIVE

Our objective was to examine the association between cortisol responses to laboratory-induced mental stress and incident hypertension.

DESIGN AND

SETTING

This was a prospective substudy of the Whitehall II cohort with 3 years follow-up of an occupational cohort.

PARTICIPANTS

Participants included 479 initially healthy men and women (mean age, 62.7 ± 5.6 yr), without history or objective signs of cardiovascular disease or hypertension at study entry.

INTERVENTION: At the baseline assessment, salivary cortisol was measured in response to mental stressors, consisting of a 5-min Stroop task and a 5-min mirror tracing task.

MAIN OUTCOME MEASURES: Blood pressure was measured at study entry and at 3 yr follow-up for the determination of hypertension.

RESULTS

There was considerable variation in the cortisol stress response, with approximately 40% of the sample responding to the stress tasks with an increase in cortisol of at least 1 mmol/liter. Over the 3 yr follow-up, 15.9% of the sample developed hypertension. There was an association between cortisol stress reactivity (per sd) and incident hypertension (odds ratio = 1.59; 95% confidence interval = 1.17-2.17) after adjustments for age, sex, resting cortisol, blood pressure at study entry, employment grade, smoking, body mass index, glycated hemoglobin, use of statins, and blood lipids.

CONCLUSION

These data support the notion that cortisol reactivity, an index of hypothalamic-pituitary-adrenal function, is one of the possible mechanisms through which psychosocial stress may influence the risk of hypertension.