Dec 14, 2022 - Health

Everything you know about stress and high blood pressure is wrong

Illustration of a blood pressure monitor with a question mark needle

Illustration: Natalie Peeples/Axios

Your hectic job, difficult marriage, rebellious children and dwindling bank account? They're probably not raising your blood pressure in a medically meaningful way, according to the latest research.

The big picture: Rather than everyday stressors, the real culprits are genetics and poor habits that are often linked to stress, like overeating, smoking and hitting the bottle.

  • Commonly prescribed regimens — such as stress reduction, biofeedback and relaxation techniques — aren't effective in lowering blood pressure in ways that confer health benefits.

Why it matters: Nearly half of U.S. adults have hypertension (high blood pressure), and only 24% of those diagnosed have it under control, per the Centers for Disease Control and Prevention.

  • Elevated blood pressure causes 12.8% of all deaths globally, the World Health Organization says.

Driving the news: While studies have shown population-wide blood pressure elevation during the highly stressful COVID-19 pandemic, the rises were modest, doctors say, and likely related to people getting less exercise, eating poorly, drinking too much and seeing their doctors less often.

  • "Our expectation was much worse," says Hiroshi Gotanda, an internist at Cedars-Sinai Medical Center in Los Angeles who led a large-scale study of hypertension during the height of the pandemic.
  • His study showed that patients measured their blood pressure less often during the first eight months of the pandemic, and that their readings were slightly higher than before the outbreak.
  • But the differences were "smaller than expected, probably because of home blood-pressure monitoring and telemedicine," says Gotanda.

Many patients actually saw their blood pressure readings improve during the pandemic probably because they weren't consuming as many salty restaurant meals, says Samuel Mann, a hypertension specialist at Weill Cornell Medicine in New York.

  • It's a "medical myth" that chronic stress causes hypertension — job stress in particular, says Mann, who reviewed dozens of studies on the topic and found no meaningful correlation.
  • "Yes, stress and emotional distress can transiently increase anyone’s blood pressure," Mann writes in a new book, "Hidden Within Us: A Radical New Understanding of the Mind-Body Connection."
  • "However, decades of mind-body research have failed to confirm that they cause sustained hypertension or that stress reduction and relaxation techniques can lead to sustained blood pressure lowering."

Yes, but: The medical community still hasn't completely dispelled the stress-blood pressure link.

  • "Increased psychosocial stress" during the pandemic may have impeded chronic hypertension management, per Gotanda's study.
  • A separate study on blood pressure levels during the pandemic, led by Luke Laffin of the Cleveland Clinic, reached similar conclusions — and also cited "emotional stress" as a possible factor.
  • The American Heart Association notes that the link between stress and high blood pressure "is still being studied."

New theory: While everyday stress doesn't cause chronic hypertension, repressed emotions — from childhood upheavals and other traumas — sometimes can, Mann writes in his new book.

  • "I'm introducing the concept of repressed emotions and their effects on our health, a concept that doesn't yet exist in medicine," he tells Axios.
  • His conclusions come from decades of interviews with patients who have hard-to-explain hypertension, who described severe traumas in their lives (from losing a child to surviving the Holocaust) yet remained upbeat.
  • Repressed emotions, whether or not we're aware of them, can cause hypertension, migraines, chronic fatigue syndrome and other conditions, Mann contends.

The bottom line: A healthy diet combined with regular exercise and good sleeping habits can control or avert hypertension, doctors say.

  • Management of blood pressure and stress "is really 70% lifestyle and 30% medications," says Laffin.
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