Chronic Psychosocial Stress and Hypertension


Genetic and behavioral factors do not fully explain the development of hypertension, and there is increasing evidence suggesting that psychosocial factors may also play an important role. Exposure to chronic stress has been hypothesized as a risk factor for hypertension, and occupational stress, stressful aspects of the social environment, and low socioeconomic status have each been studied extensively. The study of discrimination is a more recent and rapidly growing area of investigation and may also help to explain the well-known racial disparities in hypertension. Research regarding mechanisms underlying stress effects on hypertension has largely focused on cardiovascular reactivity, but delayed recovery to the pre-stress level is increasingly being evaluated as another possible pathway. Recent findings in each of these areas are reviewed, and directions for future research are discussed.

This is a preview of subscription content, access via your institution.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Cohen S, Janicki-Deverts D, Miller GE: Psychological stress and disease. JAMA 2007, 298:1685–1687.

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Sparrenberger F, Cichelero FT, Ascoli AM, et al.: Does psychosocial stress cause hypertension? A systematic review of observational studies. J Hum Hypertens 2009, 23:12–19.

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Karasek RA, Baker D, Marxer F, et al.: Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men. Am J Public Health 1981, 71:694–705.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Schwartz JE, Pickering TG, Landsbergis PA: Work-related stress and blood pressure: current theoretical models and considerations from a behavioral medicine perspective. J Occup Health Psychol 1996, 1:287–310.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Siegrist J: Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996, 1:27–41.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Vrijkotte TGM, van Doornen LJP, de Geus EJC: Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension 2000, 35:880–886.

    CAS  PubMed  Google Scholar 

  7. 7.

    Steptoe A, Siegrist J, Kirschbaum C, Marmot C: Effort-reward imbalance, overcommitment, and measures of cortisol and blood pressure over the working day. Psychosom Med 2004, 66:323–329.

    Article  PubMed  Google Scholar 

  8. 8.

    Markovitz JH, Matthews KA, Whooley M, et al.: Increases in job strain are associated with incident hypertension in the CARDIA Study. Ann Behav Med 2004, 28:4–9.

    Article  PubMed  Google Scholar 

  9. 9.

    Guimont C, Brisson C, Dagenais GR, et al.: Effects of job strain on blood pressure: a prospective study of male and female white-collar workers. Am J Public Health 2006, 96:1436–1439.

    Article  PubMed  Google Scholar 

  10. 10.

    • Tobe SW, Kiss A, Sainsbury S, et al.: The impact of job strain and marital cohesion on ambulatory blood pressure during 1 year: the Double Exposure study. Am J Hypertens 2007, 20:148–153. This study evaluated the interactive effects of two potent chronic stressors, job strain and marital stress, and demonstrated sex differences in their relationship with ambulatory BP changes over 1 year.

  11. 11.

    Ohlin B, Berglund G, Rosvall M, Nilsson PM: Job strain in men, but not in women, predicts a significant rise in blood pressure after 6.5 years of follow-up. J Hypertens 2007, 25:525–531.

    Article  PubMed  Google Scholar 

  12. 12.

    Fauvel JP, M’Pio I, Quelin P, et al.: Neither perceived job stress nor individual cardiovascular reactivity predict high blood pressure. Hypertension 2003, 42:1112–1116.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Kamarck TW, Janicki DL, Shiffman S, et al.: Psychosocial demands and ambulatory blood pressure: a field assessment approach. Physiol Behav 2002, 77:699–704.

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Levenstein S, Smith MW, Kaplan GA: Psychosocial predictors of hypertension in men and women. Arch Intern Med 2001, 161:1341–1346.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Kawachi I, Colditz GA, Ascherio A, et al.: A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA. J Epidemiol Community Health 1996, 50:245–251.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Steptoe A, Marmot M: Psychosocial, hemostatic, and inflammatory correlates of delayed poststress blood pressure recovery. Psychosom Med 2006, 531–537.

  17. 17.

    Steptoe A, Owen N, Kunz-Ebrecht SR, Brydon L: Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology 2004, 29:593–611.

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Hawkley LC, Masi CM, Berry JD, Cacioppo JT: Loneliness is a unique predictor of age-related differences in systolic blood pressure. Psychol Aging 2006, 21:152–164.

    Article  PubMed  Google Scholar 

  19. 19.

    Robles TF, Kiecolt-Glaser JK: The physiology of marriage: pathways to health. Physiol Behav 2003, 79:409–416.

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    • Holt-Lunstad J, Birmingham W, Jones BQ: Is there something unique about marriage? The relative impact of marital status, relationship quality, and network social support on ambulatory blood pressure and mental health. Ann Behav Med 2008, 35:239–244. This study demonstrated the greater importance of marital quality over marital status for ambulatory BP, and also showed that having a supportive social network did not buffer the negative effects of being single or in an unhappy marriage.

  21. 21.

    Nealey-Moore JB, Smith TW, Uchino BN, et al.: Cardiovascular reactivity during positive and negative marital interactions. J Behav Med 2007, 30:505–519.

    Article  PubMed  Google Scholar 

  22. 22.

    Smith TW, Uchino BN, Berg CA, et al.: Conflict and collaboration in middle-aged and older couples: II. Cardiovascular reactivity during marital interaction. Psychol Aging 2009, 24:274–286.

    Article  PubMed  Google Scholar 

  23. 23.

    Grewen KM, Girdler SS, Light KC: Relationship quality: effects on ambulatory blood pressure and negative affect in a biracial sample of men and women. Blood Press Monit 2005, 10:117–124.

    Article  PubMed  Google Scholar 

  24. 24.

    Baker B, Paquette M, Szalai JP, et al.: The influence of marital adjustment on 3-year left ventricular mass and ambulatory blood pressure in mild hypertension. Arch Intern Med 2000, 160:3453–3458.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Orth-Gomer K, Wamala SP, Horsten M, et al.: Marital stress worsens prognosis in women with coronary heart disease: the Stockholm Female Coronary Risk Study. JAMA 2000, 284:3008–3014.

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Kiecolt-Glaser JK, Newton TL: Marriage and health: his and hers. Psychol Bull 2001, 127:472–503.

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Adler NE, Ostrove JM: Socioeconomic status and health: what we know and what we don’t. Ann NY Acad Sci 1999, 896:3–15.

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Albert MA, Glynn RJ, Buring J, Ridker PM: Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events. Circulation 2006, 114:2619–2626.

    Article  PubMed  Google Scholar 

  29. 29.

    • Seeman T, Merkin SS, Crimmins E, et al.: Education, income and ethnic differences in cumulative biological risk profiles in a national sample of US adults: NHANES III (1988–1994). Soc Sci Med 2008, 66:72–87. This article demonstrates significant graded associations between socioeconomic status and blood pressure and other biologic parameters in a large, nationally representative sample, independent of age, gender, ethnicity, and health behaviors.

  30. 30.

    Conen D, Glynn RJ, Ridker PM, et al.: Socioeconomic status, blood pressure progression, and incident hypertension in a prospective cohort of female health professionals. Eur Heart J 2009, 30:1378–1384.

    Article  PubMed  Google Scholar 

  31. 31.

    Stepnowsky CJ, Nelesen RA, DeJardin D, Dimsdale JE: Socioeconomic status is associated with nocturnal blood pressure dipping. Psychosom Med 2004, 66:651–655.

    Article  PubMed  Google Scholar 

  32. 32.

    Spruill TM, Gerin W, Ogedegbe G, et al.: Socioeconomic and psychosocial factors mediate race differences in nocturnal blood pressure dipping. Am J Hypertens 2009, 22:637–642.

    Article  PubMed  Google Scholar 

  33. 33.

    Landsbergis PA, Schnall PL, Pickering TG, et al.: Lower socioeconomic status among men in relation to the association between job strain and blood pressure. Scand J Work Environ Health 2003, 29:206–215.

    PubMed  Google Scholar 

  34. 34.

    Matthews KA, Kiefe CI, Lewis CE, et al.: Socioeconomic trajectories and incident hypertension in a biracial cohort of young adults. Hypertension 2002, 39:772–776.

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Steptoe A, Brydon L, Kunz-Ebrecht S: Changes in financial strain over three years, ambulatory blood pressure, and cortisol responses to awakening. Psychosom Med 2005, 67:281–287.

    Article  PubMed  Google Scholar 

  36. 36.

    Mujahid MS, Diez Roux AV, Morenoff JD, et al.: Neighborhood characteristics and hypertension. Epidemiology 2008, 19:590–598.

    Article  PubMed  Google Scholar 

  37. 37.

    Brondolo E, Rieppi R, Kelly KP, Gerin W. Perceived racism and blood pressure: a review of the literature and conceptual and methodological critique. Ann Behav Med 2003, 25:55–65.

    Article  PubMed  Google Scholar 

  38. 38.

    • Williams DR, Mohammed SA: Discrimination and racial disparities in health: evidence and needed research. J Behav Med 2009, 32:20–47. This review of cross-sectional, laboratory, and prospective studies of the effects of discrimination on psychological and physical health outcomes also discusses measurement issues and hypothesized mechanisms of these effects.

  39. 39.

    Brondolo E, Brady ver Halen N, Pencille M, et al.: Coping with racism: a selective review of the literature and a theoretical and methodological critique. J Behav Med 2009, 32:64–88.

    Article  PubMed  Google Scholar 

  40. 40.

    Lepore SJ, Revenson TA, Weinberger SL, et al.: Effects of social stressors on cardiovascular reactivity in black and white women. Ann Behav Med 2006, 31:120–127.

    Article  PubMed  Google Scholar 

  41. 41.

    Merritt MM, Bennett GG, Williams RB, et al.: Perceived racism and cardiovascular reactivity and recovery to personally relevant stress. Health Psychol 2006, 25:364–369.

    Article  PubMed  Google Scholar 

  42. 42.

    Brondolo E, Thompson S, Brady N, et al.: The relationship of racism to appraisals and coping in a community sample. Ethn Dis 2005, 15(4 Suppl 5):14–19.

    Google Scholar 

  43. 43.

    Richman LS, Bennett GG, Pek J, et al.: Discrimination, dispositions, and cardiovascular responses to stress. Health Psychol 2007, 26:675–683.

    Article  PubMed  Google Scholar 

  44. 44.

    Steffen PR, McNeilly M, Anderson N, Sherwood A: Effects of perceived racism and anger inhibition on ambulatory blood pressure in African Americans. Psychosom Med 2003, 65:746–750.

    Article  PubMed  Google Scholar 

  45. 45.

    Brondolo E, Libby DJ, Denton E, et al.: Racism and ambulatory blood pressure in a community sample. Psychosom Med 2008, 70:49–56.

    Article  PubMed  Google Scholar 

  46. 46.

    Davis SK, Liu Y, Quarells RC, Din-Dzietharn R: Stress-related racial discrimination and hypertension likelihood in a population-based sample of African Americans: the Metro Atlanta Heart Disease Study. Ethn Dis 2005, 15:585–593.

    PubMed  Google Scholar 

  47. 47.

    Cozier Y, Palmer JR, Horton NJ, et al.: Racial discrimination and the incidence of hypertension in US black women. Ann Epidemiol 2006, 16:681–687.

    Article  PubMed  Google Scholar 

  48. 48.

    McEwen BS: Protective and damaging effects of stress mediators. N Engl J Med 1998, 338:171–179.

    Article  CAS  PubMed  Google Scholar 

  49. 49.

    Light KC, Girdler SS, Sherwood A, et al.: High stress responsivity predicts later blood pressure only in combination with positive family history and high life stress. Hypertension 1999, 33:1458–1464.

    CAS  PubMed  Google Scholar 

  50. 50.

    Treiber FA, Kamarck T, Schneiderman N, et al.: Cardiovascular reactivity and development of preclinical and clinical disease states. Psychosom Med 2003, 65:46–62.

    PubMed  Google Scholar 

  51. 51.

    Ming EE, Adler GK, Kessler RC, et al.: Cardiovascular reactivity to work stress predicts subsequent onset of hypertension: the Air Traffic Controller Health Change Study. Psychosom Med 2004, 66:459–465.

    Article  PubMed  Google Scholar 

  52. 52.

    Brosschot JF, Pieper S, Thayer JF: Expanding stress theory: prolonged activation and perseverative cognition. Psychoneuroendocrinology 2005, 30:1043–1049.

    Article  PubMed  Google Scholar 

  53. 53.

    Gerin W, Davidson KW, Christenfeld NJ, et al.: The role of angry rumination and distraction in blood pressure recovery from emotional arousal. Psychosom Med 2006, 68:64–72.

    Article  PubMed  Google Scholar 

  54. 54.

    Cropley M, Dijk DJ, Stanley N: Job strain, work rumination, and sleep in school teachers. Eur J Work Organ Psychol 2006, 15:181–196.

    Article  Google Scholar 

  55. 55.

    Carels RA, Szczepanski R, Blumenthal JA, Sherwood A: Blood pressure reactivity and marital distress in employed women. Psychosom Med 1998, 60:639–643.

    CAS  PubMed  Google Scholar 

  56. 56.

    Glynn LM, Christenfeld N, Gerin W: Recreating cardiovascular responses with rumination: The effects of a delay between harassment and its recall. Int J Psychophysiol 2007, 66:135–140.

    Article  PubMed  Google Scholar 

  57. 57.

    Glynn LM, Christenfeld N, Gerin W: The role of rumination in recovery from reactivity: cardiovascular consequences of emotional states. Psychosom Med 2002, 64:714–726.

    Article  PubMed  Google Scholar 

  58. 58.

    Neumann SA, Waldstein SF, Sollers JJ, et al.: Hostility and distraction have differential influences on cardiovascular recovery from anger recall in women. Health Psychol 2004, 23:631–640.

    Article  PubMed  Google Scholar 

  59. 59.

    Ray RD, Wilhelm FH, Gross JJ: All in the mind’s eye? Anger rumination and reappraisal. J Pers Soc Psychol 2008, 94:133–145.

    Article  PubMed  Google Scholar 

  60. 60.

    Kross E, Ayduk O, Mischel W: When asking “why” does not hurt: distinguishing rumination from reflective processing of negative emotions. Psychol Sci 2005, 16:709–715.

    Article  PubMed  Google Scholar 

  61. 61.

    Ayduk O, Kross E: Enhancing the pace of recovery: self-distanced analysis of negative experiences reduces blood pressure reactivity. Psychol Sci 2008, 19:229–231.

    Article  PubMed  Google Scholar 

  62. 62.

    Rainford MV, Schneider RH, Nidich SI, et al.: Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Curr Hypertens Rep 2007, 9:520–528.

    Article  Google Scholar 

  63. 63.

    Jain S, Shapiro SL, Swanick S, et al.: A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Ann Behav Med 2007, 33:11–21.

    Article  PubMed  Google Scholar 

Download references


Preparation of this article was supported in part by the National Heart, Lung, and Blood Institute, National Institutes of Health, grants HL47540, HL76857, and HL86734. The sponsors had no role in the writing of the present report, or in the decision to submit the manuscript for publication.


No potential conflicts of interest relevant to this article were reported.

Author information



Corresponding author

Correspondence to Tanya M. Spruill.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Spruill, T.M. Chronic Psychosocial Stress and Hypertension. Current Science Inc 12, 10–16 (2010).

Download citation


  • Chronic stress
  • Blood pressure
  • Hypertension
  • Rumination