Indexes of perceived stress and anxiety: an observational study in newly evaluated hypertensive patients

Background: Chronic stress and anxiety are frequently associated with arterial hypertension (Greenage et al. Curr Atheroscler Rep, 2010) and related to sympathetic activation and hypothalamic, hypophyseal and adrenal activation. A link between plasma aldosterone and stress/anxiety has also been recently suggested both in animals and humans, particularly in women (Jezova and Hlavacova, Ann. N.Y.Acad.Sci, 2008). Objective: To investigate in hypertensive subjects the relationships between emotional stress and anxiety with endocrine or hemodynamic parameters as assessed in a routine diagnostic workup for arterial hypertension. Design and Methods: An observational study was started in day-hospital hypertensive patients (n = 74 up to date, 38M, 36F; mean age ?SD 53 ?14), including two questionnaires for self-perceived stress (PSS10) and anxiety (TAS-20)respectively, which were administered on first-evaluation day, soon after (9.00-9:30am) blood pressure and heart rate measurements (by automatic device) and blood samples withdrawal for PRA, aldosterone and cortisol determinations according to standardized procedures. Results: The scores of the two tests were directly related with each other (p < .0001). For both, a positive association was found with heart rate and a negative one with cortisol levels, more significantly (p < .05 and p < 0.01 respectively) after the exclusion of cases (n = 14) who had positive screening criteria for primary aldosteronism. Anxiety scores were negatively related to cortisol levels particularly in women. No other significant differences or relationships were observed. Conclusions: These preliminary up-to-date results were unable to confirm a significant association between plasma aldosterone and anxiety/stress profiles in hypertensive patients as previously suggested by others. The relationship of anxiety and perceived stress scores with heart rate but not blood pressure levels may be explained by an higher sensitivity of heart rate as an index of sympathetic activation, suggesting it as a sensitive marker of anxiety level in the diagnostic evaluation and follow up of hypertensive patients. Interestingly, in our patients cortisol levels appeared unexpectedly to be negatively related to stress profiles, suggesting a possible primary defect in coping with emotional stress and anxiety in arterial hypertension.