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Stress may play a role in the etiology of cardiovascular disease. Research showing that mental stress administered in laboratory settings causes great change in cardiovascular and hemodynamic functioning supports this hypothesis. In a small sample of physicians and dentists, those who showed greater cardiovascular reactivity (hot reactors) to stress were more likely to be hyperlipidemic or to have had a myocardial infarction or coronary bypass surgery. In addition, some of the nonreactive group were hypertensives taking medication, which may have blunted their response to stress. Persons with higher cholesterol, higher triglyceride levels, and lower HDL levels all showed greater increases in blood pressure (BP) in response to stress. Also, the reactive group reported less emotional support and experienced greater numbers of family-related stressful events in the previous year. The degree of aerobic fitness influenced resting hemodynamics and percentage of body fat but not reactivity to stress. Likewise, smoking did not affect reactivity, but former smokers did have a significantly elevated total systemic resistance at rest. While it is impossible to say whether reactivity causes disease, is the result of the presence of risk factors and disease, or is caused by some other factor which also contributes to disease, these results suggest that the presence of cardiovascular reactivity to mental stress is a sign of potential illness and indicates the need for further medical and risk factor study of the patient.

In this article, the most important risk factors that may predict the transition from borderline to established hypertension are reviewed. Primary prevention has to focus on identifying individuals who are at highest risk and delaying or reversing further elevation of arterial pressure levels. A review of the literature indicates that several environmental and congenital factors can be identified as risk factors for the development of hypertension, including family history of essential hypertension, age, race, obesity, alcohol consumption, salt intake, hormonal status, and some stress factors. Of all diagnostic approaches to predict the development of hypertension, measurements of resting heart rate and responses to dynamic exercise have some predictive value.