ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 EP3 | DOI: 10.1530/endoabs.63.EP3

Depression and anxiety are positively correlated with higher concentrations of cortisol and blood pressure in hypertensive cardiovascular disease patients

Shiza Unab1, Maleeha Akram1, Fahim Tahir2, Sarwat Jahan3, Ali Raza Kazmi4, Kiran Afshan3, Afzaal Ahmed Naseem5, Mazhar Qayyum1, Muhammad Rafi6 & Syed Shakeel Raza Rizvi1,7


1Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan; 2Reproductive Physiology, Public Health Laboratories Division, National Institute of Health (NIH), Islamabad, Pakistan; 3Department of Animal Sciences, Quaid-e-Azam University, Islamabad, Pakistan; 4Aga Khan Health Centre, Rawalpindi, Pakistan; 5University of Lahore, Islamabad Campus, Islamabad, Pakistan; 6Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad, Pakistan; 7Department of Zoology, University of Central Punjab, Rawalpindi, Pakistan.


Hypertension or high blood pressure (HBP) has been counted as the chief cause and most significant factor in the development of cardiovascular diseases (CVDs) worldwide. Stress has been defined as an inner process that happens when a person is faced with an ordinant dictation that is perceived to go beyond the resources available to efficaciously respond to it. Cortisol is a hormone released from the zona fasciculata of the adrenal cortex during the times of stress. This biological marker of stress can directly influence the central nervous system, as it affects areas of the brain having responsibility of controlling the blood pressure. Cortisol reactivity, an index of hypothalamic-pituitary-adrenal function, is one of the possible ways through which psychosocial stress may affect the liability of hypertension. The present study was designed to examine stress as a predisposing factor in causing hypertension by determining the level of psychological stress using Depression, Anxiety and Stress Scale (DASS), the level of physiological stress in terms of release of cortisol by using RIA systems and their association with hypertension. Hundred hypertensive CVD patients and hundred age and sex matched healthy subjects between the age of 20 and 60 years were included in the study. Our results revealed that hypertensive CVD patients scored higher on DASS as compared to controls. The majority of hypertensive CVD patients had combined symptoms of depression, anxiety and stress. Similarly, cortisol concentrations were found to be significantly higher in hypertensive CVD patients as compared to healthy subjects in all age groups from 31 to 60 years. There was a strong positive correlation between psychological stress and cortisol in hypertensive CVD patients. Furthermore, there was a positive correlation between depression and anxiety and BP as well as between cortisol and BP, while there was a negative correlation between stress and BP in hypertensive CVD patients in all age groups. The majority of hypertensive CVD patients fell in the age group of 51–60 years. They were males, belonging to the lower-middle class, and were illiterate, overweight, married and non-smokers. They had complaints of headache and sleep apnea with no family history for CVD and were hypertensive from 1 to 10 years. They were treated with a combination of RAASi and non-RAASi. Only 6 patients were taking anti-depressants and other stress medicines. In conclusion, the present study demonstrated that increased psychological stress causes higher secretion of cortisol, which may contribute to the development of hypertension and related CVDs.