The study focused on 412 adults without hypertension or cardiovascular disease who had urine tests for levels of four stress hormones — norepinephrine, epinephrine, dopamine, and cortisol. With each doubling of hormone levels in those urine tests, the risk of developing hypertension rose by 21 to 31 percent over a median follow-up period of 6.5 years. Over a longer follow-up period — a median of 11.2 years — 5.8 percent of the people in the study experienced cardiovascular disease events like heart attacks and strokes. The risk of these events climbed by 90 percent with each doubling of cortisol levels in the urine tests — regardless of whether or not people had other risk factors, like hypertension, smoking, obesity, diabetes, or being physically inactive. “The stress hormones norepinephrine, epinephrine, dopamine, and cortisol can increase with stress from life events, work, relationships, finances, and more,” says lead study author Kosuke Inoue, MD, PhD, an epidemiologist at Kyoto University in Japan and at the University of California in Los Angeles. With two hormones in particular, cortisol and dopamine, the connection between stress hormone levels and hypertension was stronger for younger adults than for people 60 years and older, the study also found. This is in line with earlier studies, including one published in Clinical and Experimental Hypertension and another published in Hypertension, that linked dopamine levels to the development of hypertension. And it also builds on evidence from earlier studies linking elevated cortisol levels to high blood pressure, including one in the Journal of Clinical Endocrinology and Metabolism and another in the European Journal of Endocrinology. Previous studies have also linked psychological stress to an elevated risk of both hypertension and cardiovascular disease events. For example, one study, published in December 2017 in Nature Reviews Cardiology, found that adults with high levels of stress in their work or personal lives have up to a 1.6-fold higher risk of stroke and coronary artery disease, a potentially fatal condition that restricts how much oxygen-rich blood reaches the heart. Another study, published in April 2019 in The BMJ, followed more 136,637 people diagnosed with a wide range of stress disorders for 27 years, along with nearly 1.4 million people who didn’t have these conditions. Each year during the study, 10.5 in every 1,000 people with stress disorders got diagnosed with high blood pressure or events like heart attacks and strokes. That compared with 6.9 cases for every 1,000 people without stress disorders. But many earlier studies focused on psychological stress and cardiovascular disease risk lacked objective measures of stress levels, Dr. Inoue says. “It is challenging to study psychosocial stress since it is personal, and its impact varies for each individual,” Inoue says. An advantage of the current study is urine tests for stress hormone levels offer one objective way to assess the toll stress takes on people, Inoue says. One limitation of the study, however, is that researchers only measured urinary stress hormones at a single point in time, and it’s possible that these levels shifted over the years in ways that may have influenced the risk of developing hypertension or experiencing cardiovascular events. It’s also not clear from the study whether it would make sense to test for urinary stress hormone levels as a way to screen people who may need closer monitoring to prevent hypertension or cardiovascular events. “Currently, these hormones are measured only when hypertension with an underlying cause or other related diseases are suspected,” Inoue says. “However, if additional screening could help prevent hypertension and cardiovascular events, we may want to measure these hormone levels more frequently.” More research is needed to pinpoint who might benefit, if at all, from measuring urinary stress hormones as a way of screening for cardiovascular event risk, says James Stahl, MD, MPH, an associate professor at the Dartmouth Geisel School of Medicine in Hanover, New Hampshire, who wasn’t involved in the new study. Urinary stress hormone tests might also be one way to measure progress when patients try to take steps to reduce stress in their lives as a tool to prevent or control hypertension, Dr. Stahl says. And these tests might also be one way for doctors to show patients the effect of stress on their bodies and encourage them to make changes, Stahl adds. At this point in time, the best approaches to stress management are ones that are already proven to work, Stahl advises. “As to what people can do about it: change their work conditions, enroll in a stress management program, exercise, eat well, and strengthen their social network,” Stahl says.
