Feelings of exhaustion, emotional distress, and pituitary and adrenocortical hormones in borderline hypertension.
OBJECTIVE
To examine whether feelings of exhaustion and emotional distress reflecting chronic perceived stress contribute to a pattern of pituitary and adrenocortical responses that would in turn be able to distinguish borderline hypertensives from normotensive controls.


METHODS
A cross-sectional study.


METHODS
Helsinki University Central Hospital.


METHODS
Twenty-one middle-aged, male borderline hypertensives (140/90 mmHg < or = blood pressure < 160/95 mmHg) and 69 healthy normotensive controls (blood pressure < 140/90 mmHg). Main outcome measures Basal pituitary-adrenocortical activity was assessed by measurements of plasma cortisol and adrenocorticotrophin concentrations during the oral glucose tolerance test. Cortisol responses to dexamethasone suppression and adrenocorticotrophin stimulation tests were measured to determine the functional pituitary-adrenocortical activity. Feelings of exhaustion, namely, feelings of excess fatigue, loss of energy, increased irritability, demoralization and emotional distress were measured using a questionnaire.


RESULTS
As has previously been shown, feelings of exhaustion and emotional distress are associated with a hormonal pattern consisting primarily of an elevation in cortisol response to adrenocorticotrophin stimulation and secondarily of dominance of cortisol in the ratio of mean basal cortisol level to mean basal adrenocorticotrophin level. This particular neuroendocrine pattern, denoting a defeat type of reaction to stress, was in turn able to distinguish borderline hypertensives from normotensive controls significantly. Adjustment for age and health-related lifestyle factors including smoking, alcohol consumption and physical activity did not alter the difference found between the groups.


CONCLUSIONS
The results suggest that the variance shared by feelings of exhaustion, emotional distress and pituitary-adrenocortical hormones could elucidate the mechanisms by which stress exerts its influence towards an increased risk for hypertension.
Räikkönen
K
K
Department of Psychology, University of Helsinki, Finland.
Hautanen
A
A
Keltikangas-Järvinen
L
L
D000305:Adrenal Cortex Hormones / Q000502:physiology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D003430:Cross-Sectional Studies; D003907:Dexamethasone; D005221:Fatigue / Q000209:etiology*; D005951:Glucose Tolerance Test; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications*; D010907:Pituitary Hormones / Q000502:physiology*; D012649:Self Concept; D013315:Stress, Psychological / Q000150:complications
D000305:Adrenal Cortex Hormones; D010907:Pituitary Hormones; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone