title: Association between chronic stress and blood pressure: findings from the German Health Interview and Examination Survey for Adults 2008-2011.
abstract: OBJECTIVE
  The magnitude of the contribution of psychosocial stressors to the development of hypertension remains controversial. Using data from the population-based, nationwide German Health Interview and Examination Survey for Adults, we investigated the relationship between objectively measured and subjectively perceived stressors and blood pressure (BP).
  
  
  METHODS
  The study sample comprised 3352 participants not taking antihypertensive medication, for whom data on stress exposure and resting BP measurements were available. The Trier Inventory for the Assessment of Chronic Stress screening scale (TICS-SSCS) was used as a measurement of self-perceived chronic stress, and work-related stress was assessed using the recently developed occupational Overall Job Index.
  
  
  RESULTS
  On the basis of bivariate tests, TICS-SSCS was negatively associated with both systolic (β-coefficient [B] = -0.16, standard error = 0.03, p < .001) and diastolic BP (B = -0.10, standard error = 0.02, p < .001). After adjustment for age, sex, and body mass index, the TICS-SSCS but not the Overall Job Index was significantly related to systolic and diastolic BP. When alcohol consumption, smoking, physical activity, residential traffic intensity, caregiving, socioeconomic status, social support, and living without a partner were added to the model, the TICS-SSCS again remained independently associated with both BP measures (p ≤ .007).
  
  
  CONCLUSIONS
  In a large and representative German study, we found that less perceived stress is associated with higher BP levels, whereas the exposure to objective stressors was unrelated to BP. These findings suggest that stress perception and objective stressors influence BP regulation via different biobehavioral pathways.
authors.affiliation: From the Department of Psychosomatic Medicine and Psychotherapy (Hassoun, Herrmann-Lingen, Meyer), University of Göttingen, Göttingen, Germany; Department of Epidemiology and Health Monitoring, Robert Koch Institute (Hapke, Neuhauser, Scheidt-Nave), Berlin, Germany; and German Center for Cardiovascular Research (Hassoun, Herrmann-Lingen, Meyer, Neuhauser, Scheidt-Nave), Göttingen, Germany.
authors.forename: Lina
authors.initials: L
authors.lastname: Hassoun
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
authors.forename: Ulfert
authors.initials: U
authors.lastname: Hapke
authors.forename: Hannelore
authors.initials: H
authors.lastname: Neuhauser
authors.forename: Christa
authors.initials: C
authors.lastname: Scheidt-Nave
authors.forename: Thomas
authors.initials: T
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D055815:Young Adult