Stress, autonomic hyperactivity and essential hypertension: an enigma.

This review shows that there is ample evidence of a stress-related hypersympathetic state in the early phase (borderline, hyperkinetic) of essential hypertension. These patients have signs of excessive autonomic cardiovascular drive (e.g. large changes in cardiac output, heart rate and pre-ejection period). After autonomic blockade these patients were also prone to suppressing anger and tended to be submissive towards other people. Research to determine whether personality traits are related to hypertension has shown that suppressed anger and submissiveness appear to be more related to sustained blood pressure elevation than to blood pressure variability. Although there is adequate evidence for a relationship between stress, personality and hypertension in borderline hypertension, it is difficult to demonstrate an autonomic nervous system component in established hypertension. Apparently mechanisms of blood pressure elevation change during the natural history of hypertension, and more research to understand the character of these changes is needed.