CHRONIC MENTAL STRESS IS A CAUSE OF ESSENTIAL HYPERTENSION: PRESENCE OF BIOLOGICAL MARKERS OF STRESS
Abstract
SUMMARY: In searching for biological evidence that essential hypertension is caused by chronic mental stress, a disputed proposition, parallels are noted with panic disorder, which provides an explicit clinical model of recurring stress responses. There is clinical comorbidity; panic disorder prevalence is increased threefold in essential hypertension. Plasma cortisol is elevated in both. In panic disorder and essential hypertension, but not in health, single sympathetic nerve fibres commonly fire repeatedly within an individual cardiac cycle; this appears to be a signature of stress exposure. For both conditions, adrenaline cotransmission is present in sympathetic nerves. Tissue nerve growth factor is increased in both (nerve growth factor is a stress reactant). There is induction of the adrenaline synthesizing enzyme, phenylethanolamine‐N‐methyltransferase, in sympathetic nerves, an explicit indicator of mental stress exposure. The question of whether chronic mental stress causes high blood pressure, still hotly debated, has been reviewed by an Australian Government body, the Specialist Medical Review Council. Despite the challenging medicolegal implications, the Council determined that stress is one proven cause of hypertension, this ruling being published in the 27 March 2002 Australian Government Gazette. This judgement was reached after consideration of the epidemiological evidence, but in particular after review of the specific elements of the neural pathophysiology of essential hypertension, described above.
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Molecular analyses of sympathetic nerves of hypertensive patients accessed by subcutaneous vein biopsy disclose the presence of the epinephrine-synthesizing enzyme phenylethanolamine-N-methyltransferase, suggesting that epinephrine is synthesized in situ in the nerves.
“Molecular analyses of sympathetic nerves of hypertensive patients accessed by subcutaneous vein biopsy disclose the presence of the epinephrine-synthesizing enzyme phenylethanolamine-N-methyltransferase, 70 suggesting that epinephrine is synthesized in situ in the nerves.”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [70]
Phenylethanolamine-N-methyltransferase is not present in the biopsied sympathetic nerves of healthy people.
“Phenylethanolamine-N-methyltransferase is not present in the biopsied sympathetic nerves of healthy people.70”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [70]
Impaired neuronal noradrenaline reuptake, as a solitary identified abnormality in patients with postural tachycardia syndrome, is not associated with heart disease or reduced longevity.
“Impaired neuronal noradrenaline reuptake, as a solitary identified abnormality in patients with the postural tachycardia syndrome, 70,82 is not associated with heart disease or reduced longevity.”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [70]
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- Authors
- Esler, M., Eikelis, N., Schlaich, M., Lambert, G., Alvarenga, M., Dawood, T., Kaye, D., Barton, D., Pier, C., Guo, L., Brenchley, C., Jennings, G., & Lambert, E.
- Affiliations
- Baker Heart and Diabetes Institute (AU)
- Corresponding author
- Esler, Murray
- ORCID
- Venue
- Clinical and Experimental Pharmacology and Physiology
- Publisher
- Wiley
- Published
- 2008-02-27
- Volume
- 35
- Issue
- 4
- Pages
- 498-502
- ISSN
- 0305-1870 (ISSN-L)
- 1440-1681
- OpenAlex
- W2025664121
- Cited by
- 170
- References
- 26
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 5 · 2023: 6 · 2022: 6 · 2021: 13 · 2020: 10 · 2019: 7 · 2018: 10 · 2017: 10 · 2016: 8 · 2015: 14 · 2014: 15 · 2013: 13 · 2012: 14
- FWCI
- 8.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical and Experimental Pharmacology and Physiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- essential hypertension, panic disorder, plasma cortisol, sympathetic activity, nerve growth factor, phenylethanolamine N-methyltransferase, stress biomarkers, comorbidities
- MeSH terms
- Humans, Hypertension, Stress, Psychological, Time Factors, Biomarkers
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