Cardiovascular Responses to Behvioral Stress and Hypertension: A Meta-Analytic Review

We report the results of a meta-analysis of case/control studies regarding the blood pressure and heart rate responses to behavioral stress of three groups and their controls: essential hypertensives, borderline hypertensives, and offspring of hypertensives. Results showed that, relative to normotensive controls, essential hypertensives exhibited large blood pressure responses during all stressors and those responses were more reliably different during passive stressors, which do not require a behavioral response, than during active stressors, which do require a behavioral response. In contrast, borderline hypertensives exhibited moderately large and more reliable blood pressure and heart rate responses, predominantly during stressors requiring an active behavioral response. Normotensive offspring of hypertensive parents also exhibited moderately large and more reliable blood pressure and heart rate responses to stressors; they showed more reliable diastolic blood pressure responses, predominantly to stressors requiring an active behavioral response. These results provide strong preliminary evidence that excessive sympathetic nervous system activity during behavioral stress can have a pathophysiologic role in the development of hypertension in some individuals.