The Relationship Between Psychosocial Stress and Hypertension

Psychosocial stress is a widespread public health concern with well-documented consequences for cardiovascular health, yet its role in the pathogenesis of hypertension remains understudied in clinical and research settings. This narrative review synthesizes the mechanistic and epidemiological evidence linking chronic psychosocial stress to hypertension, with particular attention to the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS) activation, and health disparities among Black Americans and LGBT individuals. Chronic stress can lead to sustained HPA activation and glucocorticoid excess, disrupting fluid and sodium balance, impairing nitric oxide production, and promoting vascular remodeling. Repeated SNS activation can also elevate catecholamine secretion, increase systemic vascular resistance, and alter baroreflex regulation contributing to persistent blood pressure elevation. These pathways may promote endothelial dysfunction and structural cardiovascular changes that make hypertension self-sustaining over time. The burden of stress-related hypertension is not equally distributed. Black Americans face elevated hypertension risk partly initiated by chronic race-based discrimination, socioeconomic and environmental conditions, healthcare access, and the physiological demands of high-effort coping. LGBT individuals similarly experience disproportionate hypertension prevalence driven by minority stress, social stigma, and inadequate access to affirming healthcare. Current non-pharmacological stress interventions including transcendental meditation (TM), biofeedback, and relaxation training show optimistic outcomes but require larger, more rigorous trials for clinical approval. Stress screening should be considered a standard component of hypertensive care, especially for marginalized populations, establishing that chronic psychosocial stress is a modifiable risk factor for hypertension. Manuscript Review History This narrative review was developed during graduate study at Boston University and received academic feedback from a faculty member. An earlier version was also evaluated through the external peer-review process at Frontiers, during which one reviewer recommended the manuscript for publication. The manuscript was not ultimately accepted for journal publication and is being made publicly available as an independent scholarly review.