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Low Social Support and Poor Emotional Regulation Are Associated with Increased Stress Hormone Reactivity to Mental Stress in Systemic Hypertension

Department of Clinical Psychology and Psychotherapy (P.H.W., C.M., L.E., K.R., S.G., U.E.), Psychological Institute, University of Zurich, CH-8044 Zurich, Switzerland; and Department of General Internal Medicine (R.v.K.), University Hospital Berne, CH-3010 Bern, Switzerland

Address all correspondence and requests for reprints to: Petra H. Wirtz, Ph.D., Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurichbergstrasse 43, CH-8044 Zurich, Switzerland. E-mail: p.wirtz{at}psychologie.unizh.ch.

Context: There is strong evidence for a physiological hyperreactivity to stress in systemic hypertension, but data on associated or potentially moderating psychological factors are scarce.

Objective: The objective of the study was to identify psychological correlates of physiological stress reactivity in systemic hypertension.

Design: This was a cross-sectional, quasiexperimentally controlled study. Study participants underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience.

Setting: The study was conducted in the population in the state of Zurich, Switzerland.

Subjects: Subjects included 22 hypertensive and 26 normotensive men (mean ± SEM 44 ± 2 yr).

Main Outcome Measures: We assessed the psychological measures social support, emotional regulation, and cognitive appraisal of the stressful situation. Moreover, we measured salivary cortisol and plasma epinephrine and norepinephrine before and after stress and several times up to 60 min thereafter as well as blood pressure and heart rate.

Results: We found poorer hedonistic emotional regulation (HER) and lower perceived social support in hypertensives, compared with normotensives (P < 0.01). Compared with normotensives, hypertensives showed higher cortisol, epinephrine, and norepinephrine secretions after stress (P < 0.038) as well as higher systolic and diastolic blood pressure (P < 0.001). Cortisol reactivity and norepinephrine secretion were highest in hypertensive men with low HER (P < 0.05). In contrast, hypertensives with high HER did not significantly differ from normotensives in both cortisol and norepinephrine secretion after stress. Epinephrine secretion was highest in hypertensives with low social support but was not different between hypertensives with high social support and normotensives.

Conclusions: The findings suggest that both low social support and low HER are associated with elevated stress hormone reactivity in systemic hypertension.

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