Stress and arterial hypertension – from pathophysiology to pharmacology

Abstract

Currently, arterial hypertension is the most massive chronic non-infectious disease of mankind. It may remain undiagnosed for years, provoking later complications, such as acute heart failure, cerebrovascular stroke, myocardial infarction, renal failure, hypertensive retinopathy, or sudden death. Primary arterial hypertension is more common, while secondary occurs in about 5–20% of cases. The recent studies have shown that stress may be a core factor in the development of essential hypertension in some patients. For the patients suffering from post-traumatic stress disorder, stress is the dominant etiological factor that leads to the disease. It has been proven that chronic stress can affect blood pressure regulation and endocrine-metabolic functions through the limbic-hypothalamic centers; therefore, it can affect the arterial hypertension development. The strong association between stress and arterial hypertension has also been confirmed in preclinical and animal studies. For the pharmacotherapy approach, the most important are beta-adrenergic blockers, angiotensin-converting enzyme (ACE) inhibitors and AT1-receptor blockers (sartans). As a second line treatment, calcium channel blockers, diuretics, alpha-adrenergic blockers, and central antihypertensive agents may be required. The anxiolytics, such as benzodiazepines, should be considered if chronic anxiety and psychosomatic disorders are present.