Hypertension and stress: A preventive approach

The most common approach to hypertension treatment is medication. Medical treatment, however, has been plagued with serious problems regarding detecting cases and maintaining compliance. By definition, the high proportion of cases diagnosed as ‘essential hypertension’ points to our inability to identify the causes of hypertension. This suggests that a psychosocial rather than a medical approach is needed if prevention is to be obtained. Such a preventive approach, based on decreasing the effects of stress, is presented. The first step—identifying individuals over-reactive to stress—was tested using Spielberger's state-trait anxiety model. Employees in five industries were screened for high blood pressure. A systematic sample and all hypertensives (SBP ≥ 160 and/or DBP ≥ 95 mm Hg) completed the State-Trait Anxiety Inventory (STAI). A-Trait as a measure of individual reactiveness to stress showed a weak relationship to hypertension. A-State, a measure of situation specific anxiety, showed a strong relationship to blood pressure. Multiple regression analyses identified obesity and A-State as the two most important modifiable risk factors for inclusion in a preventive program.