Adrenocortical responses to psychological stress and risk for hypertension

Excessive and prolonged stress-induced cortisol changes may contribute to o r be a marker of essential hypertension. Cortisol is a central component of the stress response, and it interacts with sympathetic and renal mechanism s contributing to increased blood pressure (BP). Although research in indiv iduals with already established hypertension failed to show consistent abno rmalities in adrenocortical output, cortisol responses to psychological str ess are greater and more persistent in persons at high risk for hypertensio n relative to low-risk normotensives. Considering the heterogeneous and mul tifactorial polygenic nature of hypertension and the fact that cortisol aff ects several BP related processes, and regulates expression of genes involv ed in BP, it is possible that this hormone is involved in at least a subtyp e of hypertension. Recent studies evaluating cortisol tissue sensitivity, c ortisol production and cortisol metabolic rate in hypertension-prone person s support the possibility that cortisol may serve as an intermediate phenot ype of hypertension. In this review, we discuss components of the stress re sponses, factors influencing the adrenocortical response, adrenocortical ac tivity in hypertension, and we propose pathways that mediate effects of str ess-induced cortisol on BP. (C) 2000 Editions scientifiques et medicales El sevier SAS.