Mental stress and human cardiovascular disease
Abstract
The London physician and neuroanatomist Thomas Willis in the 17th century correctly attributed the source of emotions to the brain, not the heart as believed in antiquity. Contemporary research documents the phenomenon of "triggered" heart disease, when the autonomic nervous system control of the heart by the brain goes awry, producing heart disease of sudden onset, precipitated by acute emotional upheaval. This can take the form of, variously, cardiac arrhythmias, myocardial infarction, Takotsubo cardiomyopathy and sudden death. Chronic psychological distress also can have adverse cardiovascular consequences, in the causal linkage of depressive illness to heart disease, and in the probable causation of atherosclerosis and hypertension by chronic mental stress. In patients with essential hypertension, stress biomarkers are present. The sympathetic nervous system is the usual mediator between these acute and chronic psychological substrates and cardiovascular disease.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Psychological stress has been shown to influence the onset of several cardiovascular diseases.
“Moreover, psychological stress has been shown to influence the onset of several cardiovascular diseases (Dar et al., 2019; Esler, 2017; Leo et al., 2023).”
From Remembering what did not happen: the role of hypnosis in memory recall and false memories formation (2025) · cites this paper as Esler, 2017
Ventricular arrhythmias in hypertensive patients with coronary artery stenosis and myocardial ischemia can represent a triggered phenomenon deriving from accentuated high cardiac sympathetic activation accompanying mental stress or strenuous exercise.
“This can represent a triggered phenomenon, deriving from the accentuated, high level of cardiac sympathetic activation accompanying mental stress or strenuous exercise.49,98”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [98]
Neural mechanisms are most likely to generate ventricular arrhythmias when coupled with coronary artery stenosis and myocardial ischemia, which is common in hypertensive patients.
“Neural mechanisms are most likely to generate ventricular arrhythmias when coupled with coronary artery stenosis and myocardial ischemia, common in hypertensive patients.”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [98]
Cites
Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J., et al. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17018-9 · Cited by 12,026 · see citing works
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
The SPRINT Research Group (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1511939 · Cited by 6,325 · see citing works
Adverse health effects of high-effort/low-reward conditions.
Siegrist, J. (1996) · Journal of Occupational Health Psychology · doi:10.1037/1076-8998.1.1.27 · Cited by 5,713 · see citing works
The Effect of Carvedilol on Morbidity and Mortality in Patients with Chronic Heart Failure
Packer, M., Bristow, M. R., Cohn, J. N., Colucci, W. S., Fowler, M. B., Gilbert, E. M., & Shusterman, N. H. (1996) · New England Journal of Medicine · doi:10.1056/nejm199605233342101 · Cited by 4,649 · see citing works
Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress
Wittstein, I. S., Thiemann, D. R., Lima, J. A. C., Baughman, K. L., Schulman, S. P., Gerstenblith, G., Wu, K. C., Rade, J. J., Bivalacqua, T. J., & Champion, H. C. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043046 · Cited by 3,108 · see citing works
Rozanski, A., Blumenthal, J. A., & Kaplan, J. (1999) · Circulation · doi:10.1161/01.cir.99.16.2192 · Cited by 2,846 · see citing works
Rosengren, A., Hawken, S., Ôunpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A., Blackett, K. N., Sitthi-amorn, C., Sato, H., & Yusuf, S. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17019-0 · Cited by 2,414 · see citing works
Depression Following Myocardial Infarction
Frasure‐Smith, N. (1993) · JAMA · doi:10.1001/jama.1993.03510150053029 · Cited by 2,028 · see citing works
Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men.
Karasek, R. A., Baker, D. B., Marxer, F., Ahlbom, A., & Theorell, T. (1981) · American Journal of Public Health · doi:10.2105/ajph.71.7.694 · Cited by 1,566 · see citing works
The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice
Rozanski, A., Blumenthal, J. A., Davidson, K. W., Saab, P. G., & Kubzansky, L. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.12.005 · Cited by 1,238 · cited 1× · see citing works
“Prior evidence, summarized in earlier reviews in Circulation (Rosanski et al, 1999) and the Journal of the American College of Cardiology (Rozanski et al, 2005), however was actually very persuasive.”
MethodChronic stress at work and the metabolic syndrome: prospective study
Chandola, T., Brunner, E., & Marmot, M. (2006) · BMJ · doi:10.1136/bmj.38693.435301.80 · Cited by 1,075 · see citing works
Sudden Cardiac Death Triggered by an Earthquake
Leor, J., Poole, W. K., & Kloner, R. A. (1996) · New England Journal of Medicine · doi:10.1056/nejm199602153340701 · Cited by 819 · see citing works
Overflow of catecholamine neurotransmitters to the circulation: source, fate, and functions
Esler, M., Jennings, G., Lambert, G., Meredith, I., Horne, M., & Eisenhofer, G. (1990) · Physiological Reviews · doi:10.1152/physrev.1990.70.4.963 · Cited by 794 · see citing works
Self-citationProspective study of phobic anxiety and risk of coronary heart disease in men.
Kawachi, I. I., Colditz, G. A., Ascherio, A., Rimm, E. B., Giovannucci, E. L., Stampfer, M. J., & Willett, W. C. (1994) · Circulation · doi:10.1161/01.cir.89.5.1992 · Cited by 563 · see citing works
“Stress” and coronary heart disease: psychosocial risk factors
Bunker, S. J., Colquhoun, D. M., Esler, M. D., Hickie, I. B., Hunt, D., Jelinek, V. M., Oldenburg, B. F., Peach, H. G., Ruth, D., Tennant, C. C., et al. (2003) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2003.tb05193.x · Cited by 560 · see citing works
Self-citationPulse and Respiratory Grouping of Sympathetic Impulses in Human Muscle Nerves
Hagbarth, K. ‐., & Vallbo, Å. B. (1968) · Acta Physiologica Scandinavica · doi:10.1111/j.1365-201x.1968.tb10904.x · Cited by 441 · see citing works
Neural mechanisms in human obesity-related hypertension
Rumantir, M. S., Vaz, M., Jennings, G. L., Collier, G., Kaye, D. M., Seals, D. R., Wiesner, G. H., Brunner-La Rocca, H. P., & Esler, M. D. (1999) · Journal of Hypertension · doi:10.1097/00004872-199917080-00012 · Cited by 396 · see citing works
Self-citationThe Kenyan Luo migration study: observations on the initiation of a rise in blood pressure.
Poulter, N. R., Khaw, K., Hopwood, B. E., Mugambi, M., Peart, W. S., Rose, G., & Sever, P. S. (1990) · BMJ · doi:10.1136/bmj.300.6730.967 · Cited by 381 · see citing works
Phobic Anxiety and Risk of Coronary Heart Disease and Sudden Cardiac Death Among Women
Albert, C. M., Chae, C. U., Rexrode, K. M., Manson, J. E., & Kawachi, I. I. (2005) · Circulation · doi:10.1161/01.cir.0000153813.64165.5d · Cited by 330 · see citing works
Sympathetic activity in major depressive disorder: identifying those at increased cardiac risk?
Barton, D. A., Dawood, T., Lambert, E. A., Esler, M. D., Haikerwal, D., Brenchley, C., Socratous, F., Kaye, D. M., Schlaich, M. P., Hickie, I., et al. (2007) · Journal of Hypertension · doi:10.1097/hjh.0b013e32829baae7 · Cited by 291 · see citing works
Self-citationEsler, M., Böhm, M., Sievert, H., Rump, C., Schmieder, R. E., Krum, H., Mahfoud, F., & Schlaich, M. P. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu209 · Cited by 260 · see citing works
Self-citationThe discharge behaviour of single vasoconstrictor motoneurones in human muscle nerves
Macefield, V. G., Wallin, B. G., & Vallbo, A. B. (1994) · The Journal of Physiology · doi:10.1113/jphysiol.1994.sp020482 · Cited by 248 · see citing works
Adrenergic Nervous System in Heart Failure
Esler, M., Kaye, D. M., Lambert, G. W., Esler, D., & Jennings, G. (1997) · The American Journal of Cardiology · doi:10.1016/s0002-9149(97)00844-8 · Cited by 227 · see citing works
Self-citationWilkinson, D. J. C., Thompson, J. M., Lambert, G. W., Jennings, G. L., Schwarz, R. G., Jefferys, D., Turner, A. G., & Esler, M. D. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.6.511 · Cited by 214 · see citing works
Self-citationThe Peripheral Kinetics of Norepinephrine in Depressive Illness
Esler, M. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290030035006 · Cited by 195 · see citing works
Self-citationDiffering Pattern of Sympathoexcitation in Normal-Weight and Obesity-Related Hypertension
Lambert, E., Straznicky, N., Schlaich, M., Esler, M., Dawood, T., Hotchkin, E., & Lambert, G. (2007) · Hypertension · doi:10.1161/hypertensionaha.107.094649 · Cited by 195 · see citing works
Self-citationChildhood Bereavement and Adult Depression
Beck, A. T. (1963) · Archives of General Psychiatry · doi:10.1001/archpsyc.1963.01720150105011 · Cited by 193 · see citing works
The long QT interval syndrome. A Rosetta stone for sympathetic related ventricular tachyarrhythmias.
Zipes, D. P. (1991) · Circulation · doi:10.1161/01.cir.84.3.1414 · Cited by 191 · see citing works
Exercise training lowers resting renal but not cardiac sympathetic activity in humans.
Meredith, I. T., Friberg, P., Jennings, G. L., Dewar, E. M., Fazio, V. A., Lambert, G. W., & Esler, M. D. (1991) · Hypertension · doi:10.1161/01.hyp.18.5.575 · Cited by 189 · see citing works
Self-citationCHRONIC MENTAL STRESS IS A CAUSE OF ESSENTIAL HYPERTENSION: PRESENCE OF BIOLOGICAL MARKERS OF STRESS
Esler, M., Eikelis, N., Schlaich, M., Lambert, G., Alvarenga, M., Dawood, T., Kaye, D., Barton, D., Pier, C., Guo, L., et al. (2008) · Clinical and Experimental Pharmacology and Physiology · doi:10.1111/j.1440-1681.2008.04904.x · Cited by 170 · see citing works
Self-citationAge and blood pressure changes. A 20-year follow-up study in nuns in a secluded order.
Timio, M., Verdecchia, P., Venanzi, S., Gentili, S., Ronconi, M., Francucci, B., Montanari, M., & Bichisao, E. (1988) · Hypertension · doi:10.1161/01.hyp.12.4.457 · Cited by 165 · see citing works
Alvarenga, M. E., Richards, J. C., Lambert, G., & Esler, M. D. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000195872.00987.db · Cited by 136 · see citing works
Self-citationNeurovascular responses to mental stress
Carter, J. R., Kupiers, N. T., & Ray, C. A. (2005) · The Journal of Physiology · doi:10.1113/jphysiol.2004.079665 · Cited by 130 · see citing works
Association of panic disorder and panic attacks with hypertension
Davies, S., Ghahramani, P., Jackson, P., Noble, T. W., Hardy, P., Hippisley‐Cox, J., Yeo, W. W., & Ramsay, L. E. (1999) · The American Journal of Medicine · doi:10.1016/s0002-9343(99)00237-5 · Cited by 116 · see citing works
Ferrier, C. P., Jennings, G., Eisenhofer, G., Lambert, G. W., Cox, H. S., Kalff, V., Kelly, M., & Esler, M. (1993) · Journal of Hypertension · doi:10.1097/00004872-199311000-00009 · Cited by 114 · see citing works
Self-citationRegion-Specific Neuropeptide Y Overflows at Rest and During Sympathetic Activation in Humans
Morris, M. J., Cox, H. S., Lambert, G. W., Kaye, D. M., Jennings, G., Meredith, I. T., & Esler, M. (1997) · Hypertension · doi:10.1161/01.hyp.29.1.137 · Cited by 107 · see citing works
Self-citationGold, P. W., Wong, M., Goldstein, D. S., Gold, H. K., Ronsaville, D. S., Esler, M., Alesci, S., Masood, A., Licinio, J., Geracioti, T. D., et al. (2005) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0503069102 · Cited by 107 · see citing works
Self-citationMeasurement of overall and cardiac norepinephrine release into plasma during cognitive challenge
Esler, M., Jennings, G., & Lambert, G. W. (1989) · Psychoneuroendocrinology · doi:10.1016/0306-4530(89)90047-4 · Cited by 101 · see citing works
Self-citationRumantir, M. S., Jennings, G. L., Lambert, G. W., Kaye, D. M., Seals, D. R., & Esler, M. D. (2000) · Journal of Hypertension · doi:10.1097/00004872-200018060-00009 · Cited by 72 · see citing works
Self-citationPanic disorder: coronary spasm as a basis for cardiac risk?
Mansour., V. M., Thompson, J. M., Esler, M., Wilkinson, D. J. C., Jennings, G., & Schwarz, R. (1998) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.1998.tb138992.x · Cited by 66 · see citing works
Self-citationVentricular myocardial catecholamines in primates.
Pierpont, G. L., DeMaster, E. G., Reynolds, S., Pederson, J. E., & Cohn, J. N. (1985) · PubMed · Cited by 52 · see citing works
Caramona, M. M., & Soares-da-Silva, P. (1985) · British Journal of Pharmacology · doi:10.1111/j.1476-5381.1985.tb08903.x · Cited by 29 · see citing works
Modulation of Catecholamine‐Synthesizing Enzymes in the Rat Heart by Repeated Immobilization Stress
Mičutková, L., KREPSOVA, K., Sabban, E. L., Križanová, O., & Květňanský, R. (2004) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1296.052 · Cited by 29 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Goldstein, D. S. (2019) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00396.2018 · Cited by 96 · see citing works
Almén, N., Lundberg, H., Sundin, Ö., & Jansson, B. (2018) · Nordic Psychology · doi:10.1080/19012276.2018.1443280 · Cited by 76 · see citing works
Esler, M., Lambert, G., Schlaich, M., Dixon, J., Sari, C. I., & Lambert, E. (2018) · Hypertension · doi:10.1161/hypertensionaha.117.09790 · Cited by 60 · see citing works
Self-citationGateway reflex: neural activation-mediated immune cell gateways in the central nervous system
Kamimura, D., Ohki, T., Arima, Y., & Murakami, M. (2018) · International Immunology · doi:10.1093/intimm/dxy034 · Cited by 12 · see citing works
Remembering what did not happen: the role of hypnosis in memory recall and false memories formation
Leo, D. G., Bruno, D., & Proietti, R. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1433762 · Cited by 7 · see citing works
- Authors
- Esler, M.
- Affiliations
- Baker Heart and Diabetes Institute (AU)
- Corresponding author
- Esler, Murray
- ORCID
- Esler, Murray
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 74
- Issue
- Pt B
- Pages
- 269-276
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W2536317907
- Cited by
- 197
- References
- 43
- Citations by year
- 2026: 11 · 2025: 26 · 2024: 20 · 2023: 34 · 2022: 24 · 2021: 18 · 2020: 26 · 2019: 14 · 2018: 13 · 2017: 10 · 2016: 1
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council of Australia
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- psychological stress, cardiovascular disease, emotional arousal, autonomic nervous system, cardiac arrhythmias, myocardial infarction, takotsubo cardiomyopathy, sudden cardiac death, depression, atherosclerosis, hypertension, essential hypertension, stress biomarkers, sympathetic nervous system, heart-brain interaction
- MeSH terms
- Autonomic Nervous System, Cardiovascular Diseases, Humans, Hypertension, Stress, Psychological, Sympathetic Nervous System
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
