title: Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress.
abstract: 1. 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. 2. There is clinical comorbidity; panic disorder prevalence is increased threefold in essential hypertension. Plasma cortisol is elevated in both. 3. 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. 4. 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. 5. 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.
authors.affiliation: Baker Heart Research Institute, Melbourne, Victoria, Australia. murray.esler@baker.edu.au
authors.forename: Murray
authors.initials: M
authors.lastname: Esler
authors.forename: Nina
authors.initials: N
authors.lastname: Eikelis
authors.forename: Markus
authors.initials: M
authors.lastname: Schlaich
authors.forename: Gavin
authors.initials: G
authors.lastname: Lambert
authors.forename: Marlies
authors.initials: M
authors.lastname: Alvarenga
authors.forename: Tye
authors.initials: T
authors.lastname: Dawood
authors.forename: David
authors.initials: D
authors.lastname: Kaye
authors.forename: David
authors.initials: D
authors.lastname: Barton
authors.forename: Ciaran
authors.initials: C
authors.lastname: Pier
authors.forename: Ling
authors.initials: L
authors.lastname: Guo
authors.forename: Celia
authors.initials: C
authors.lastname: Brenchley
authors.forename: Garry
authors.initials: G
authors.lastname: Jennings
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lambert
mesh_terms: D015415:Biomarkers / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000097:blood*; D013315:Stress, Psychological / Q000097:blood*; D013997:Time Factors
chemical_list: D015415:Biomarkers