Elevated Urinary Stress Hormones Up Risk for Hypertension, CV Events in Prospective Cohort Study

Each doubling of levels of 4 stress hormones was associated with a 21-31% increase in risk of developing hypertension over a median 6.5-year follow-up.

Elevated levels of urinary stress hormones are associated with an increased risk for incident hypertension and cardiovascular events among adults free of hypertension, according to research results published online September 13, 2021, in the journal Hypertension.

Study investigators, led by Kosuke Inoue, MD, PhD, from the UCLA Fielding School of Public Health in Los Angeles, point to the role of psychosocial stress in the pathogenesis of hypertension and CV disease. Inoue notes, in a statement from the American Heart Association, that previous research has focused “on the relationship between stress hormone levels and hypertension or cardiovascular events in patients with existing hypertension.” He notes the lack of studies that look prospectively at the relationship in adults without hypertension as impetus for his current work.

“It is important to examine the impact of stress on adults in the general population because it provides new information about whether routine measurement of stress hormones needs to be considered to prevent hypertension and CVD events," said Inoue in the AHA statement.

Inoue et al conducted a prospective cohort study involving 412 adults aged 48 to 87 years free of hypertension from a substudy of the Multi-Ethnic Study of Atherosclerosis (MESA). Participants had available measurements of urinary stress hormones (norepinephrine, epinephrine, dopamine, and cortisol). The adjusted hazard ratio (aHR) of incident hypertension and cardiovascular events was estimated according to urinary stress hormone levels.

Participants average age was 61.2 years; 50% were women; 54% were Hispanic, 22%, Black, and 24% White.

Median follow-up time was 6.5 years. Investigators report the risk for incident hypertension during that period was increased per doubling of norepinephrine (aHR, 1.31 [95% confidence interval [CI], 1.06–1.61]), epinephrine (aHR, 1.21 [95% CI, 1.03–1.41]), dopamine (aHR, 1.28 [95% CI, 1.00–1.64]), and cortisol (aHR, 1.23 [95% CI, 1.04–1.44]). Inoue and colleagues found that in general the associations were stronger among participants aged <60 years vs those ≥60 years and in particular for dopamine (Pinteraction, 0.04) and cortisol (Pinteraction, 0.04).

During a median follow-up of 11.2 years, there was an increased risk of incident cardiovascular events per doubling of cortisol (aHR, 1.90 [95% CI, 1.16–3.09]), but not for catecholamines.

"The next key research question is whether and in which populations increased testing of stress hormones could be helpful. Currently, these hormones are measured only when hypertension with an underlying cause or other related diseases are suspected," said Inoue in the AHA statement. "However, if additional screening could help prevent hypertension and cardiovascular events, we may want to measure these hormone levels more frequently."

Study limitations, according to authors, included the exclusion of individuals with hypertension at initiation of the study which would have created a larger participant population and also exclusive use of urinalysis for stress hormone measurement.

Reference: Inoue K, Horwich T, Bhatnagar R, et al. Urinary stress hormones, hypertension, and cardiovascular events: The Multi-Ethnic Study of Atherosclerosis. Published online ahead of print September 13, 2021.