ASSOCIATION BETWEEN CHRONIC STRESS, CORTISOL LEVELS, AND UNCONTROLLED HYPERTENSION CROSS-SECTIONAL ANALYTICAL STUDY

Abstract

Background: Hypertension remains a major contributor to cardiovascular morbidity worldwide, and achieving adequate blood pressure control remains challenging in many patients despite available treatment options. Increasing evidence suggests that chronic psychological stress and prolonged activation of stress-related biological pathways may influence blood pressure regulation. Cortisol, a key hormone of the hypothalamic-pituitary-adrenal (HPA) axis, may act as an important marker of long-term stress exposure and cardiovascular risk. This study aimed to evaluate the association between chronic stress, cortisol levels, and uncontrolled hypertension among patients attending a tertiary care hospital in Lahore, Pakistan.

Methods: A cross-sectional analytical study was conducted among adult hypertensive patients receiving care at a tertiary care hospital in Lahore. Participants were categorized into controlled and uncontrolled hypertension groups based on their blood pressure status. Demographic and clinical information was collected through a structured questionnaire. Psychological stress was assessed using the Perceived Stress Scale (PSS-10), while serum cortisol levels were measured as a biological indicator of stress response. Blood pressure measurements were obtained using standardized clinical procedures. Statistical analysis was performed to determine associations between stress scores, cortisol levels, and hypertension control status.

Results: A total of 240 hypertensive patients were included, with 120 participants in each group. Patients with uncontrolled hypertension demonstrated significantly higher perceived stress scores compared with controlled hypertensive patients (27.1 ± 5.6 vs. 15.4 ± 4.8, p < 0.001). Serum cortisol levels were also significantly elevated among uncontrolled hypertensive patients (22.6 ± 6.3 µg/dL) compared with the controlled group (13.8 ± 4.5 µg/dL, p < 0.001). Higher stress categories were more frequently observed among patients with uncontrolled blood pressure. A positive association was observed between psychological stress, cortisol concentration, and elevated blood pressure values.

Conclusion: The findings indicate that chronic stress and increased cortisol levels are significantly associated with uncontrolled hypertension. These results highlight the importance of considering psychological and biological stress factors in routine hypertension management. Incorporating stress assessment and supportive interventions alongside standard antihypertensive therapy may improve blood pressure control and provide a more comprehensive approach to cardiovascular risk reduction.