Cortisol responses to mental stress and incident hypertension in healthy men and women.

CONTEXT: Heightened cardiovascular responses to mental stressors are associated with future risk of hypertension. The role of cortisol, a key stress hormone produced by the hypothalamic-pituitary-adrenal axis, remains unclear.

OBJECTIVE: Our objective was to examine the association between cortisol responses to laboratory-induced mental stress and incident hypertension.

DESIGN AND SETTING: This was a prospective substudy of the Whitehall II cohort with 3 years follow-up of an occupational cohort.

PARTICIPANTS: Participants included 479 initially healthy men and women (mean age, 62.7 ± 5.6 yr), without history or objective signs of cardiovascular disease or hypertension at study entry.

INTERVENTION: At the baseline assessment, salivary cortisol was measured in response to mental stressors, consisting of a 5-min Stroop task and a 5-min mirror tracing task.

MAIN OUTCOME MEASURES: Blood pressure was measured at study entry and at 3 yr follow-up for the determination of hypertension.

RESULTS: There was considerable variation in the cortisol stress response, with approximately 40% of the sample responding to the stress tasks with an increase in cortisol of at least 1 mmol/liter. Over the 3 yr follow-up, 15.9% of the sample developed hypertension. There was an association between cortisol stress reactivity (per sd) and incident hypertension (odds ratio = 1.59; 95% confidence interval = 1.17-2.17) after adjustments for age, sex, resting cortisol, blood pressure at study entry, employment grade, smoking, body mass index, glycated hemoglobin, use of statins, and blood lipids.

CONCLUSION: These data support the notion that cortisol reactivity, an index of hypothalamic-pituitary-adrenal function, is one of the possible mechanisms through which psychosocial stress may influence the risk of hypertension.