Feelings of exhaustion, emotional distress, and pituitary and adrenocortical hormones in borderline hypertension

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ObjectiveTo examine whether feelings of exhaustion and emotional distress reflecting chronic perceived stress contribute to a pattern of pituitary and adrenocortical responses that would in turn be able to distinguish borderline hypertensives from normotensive controls.DesignA cross-sectional study.SettingHelsinki University Central Hospital.ParticipantsTwenty-one middle-aged, male borderline hypertensives (140/90 mmHg≤blood pressure<160/95mmHg) and 69 healthy normotensive controls (blood pressure<140/90 mmHg).Main outcome measuresBasal pituitary-adrenocortical activity was assessed by measurements of plasma cortisol and adrenocorticotrophin concentrations during the oral glucose tolerance test Cortisol responses to dexamethasone suppression and adrenocorticotrophin stimulation tests were measured to determine the functional pituitary- adrenocortical activity. Feelings of exhaustion, namely, feelings of excess fatigue, loss of energy, increased irritability, demoralization and emotional distress were measured using a questionnaire.ResultsAs has previously been shown, feelings of exhaustion and emotional distress are associated with a hormonal pattern consisting primarily of an elevation in cortisol response to adrenocorticotrophin stimulation and secondarily of dominance of cortisol in the ratio of mean basal cortisol level to mean basal adrenocorticotrophin level. This particular neuroendocrine pattern, denoting a defeat type of reaction to stress, was in turn able to distinguish borderline hypertensives from normotensive controls significantly. Adjustment for age and healthrelated lifestyle factors including smoking, alcohol consumption and physical activity did not alter the difference found between the groups.ConclusionsThe results suggest that the variance shared by feelings of exhaustion, emotional distress and pituitaryadrenocortical hormones could elucidate the mechanisms by which stress exerts its influence towards an increased risk for hypertension.

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