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: To identify psychological correlates of physiological stress reactivity in systemic hypertension.

Design: Cross-sectional quasi-experimentally controlled study. Study participants underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience.

Setting: Population, state of Zurich, Switzerland

Subjects: 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's<0.01). Compared with normotensives, hypertensives showed higher cortisol, epinephrine, and norepinephrine secretions after stress (p's<0.038), as well as higher systolic and diastolic blood pressure (p's<0.001). Cortisol reactivity and norepinephrine secretion were highest in hypertensive men with low HER (p's<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 low social support and low HER both are associated with elevated stress hormone reactivity in systemic hypertension.