The Silent Killer: Stress, Hypertension, and the Quest for Calm

April 11, 2024 - Omar Chaker, PharmD

The Silent Killer: Stress, Hypertension, and the Quest for Calm
The Silent Killer: Stress, Hypertension, and the Quest for Calm
Photo Credit: Elliot Manches via Centre for Ageing Better



Hypertension, commonly known as high blood pressure, poses a significant health risk when left uncontrolled, potentially leading to heart disease, stroke, and kidney disease. It is often termed the “silent killer” due to its subtle symptoms.1 Nearly half of American adults have hypertension, defined as a systolic blood pressure greater than 130 mm Hg or a diastolic blood pressure greater than 80 mm Hg, or are taking medication for hypertension.2 April, recognized as Stress Awareness Month, serves as a time to spotlight the intricate link between chronic stress and hypertension. Managing stress can improve mental and physical well-being and minimize exacerbation of health-related issues.3 In this post, we delve into the connection between stress and hypertension, discuss the role of stress management techniques and antihypertensive medications, and explore the newest advancements in stress and hypertension management. 

The Silent Killer: Stress, Hypertension, and the Quest for Calm
Photo Credit: In-Press Photography via Centre for Ageing Better

The Physiology of Stress and Hypertension


Chronic stress triggers hormonal surges that temporarily elevate blood pressure. When such conditions become routine, they pave the way for sustained high blood pressure, or hypertension. When faced with a stressor, the body initiates a complex, coordinated response known as the fight or flight reaction. This response is mediated by the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis, two key components of the body’s stress response system.4  


The SNS responds to stress by releasing catecholamines, primarily adrenaline (also called epinephrine) and noradrenaline (also called norepinephrine), into the bloodstream. These hormones increase heart rate and the force of heart contraction and constrict blood vessels, leading to an immediate rise in blood pressure. This acute response is designed to prepare the body to face or escape from perceived threats.4 


The HPA axis is also activated by stress. The hypothalamus stimulates the pituitary gland to secrete adrenocorticotropic hormone, which stimulates the adrenal glands to release cortisol, a stress hormone that is widely understood to play a role in maintaining homeostasis during stress. Under stressful circumstances, cortisol promotes endoplasmic glucose production to provide our bodies energy; however, chronically elevated cortisol levels can lead to several negative effects, including increased blood pressure, sodium and water retention, and is even suggested to affect endothelial function in blood vessels, all factors contributing to sustained hypertension.4 


Another crucial system involved in blood pressure regulation is the renin-angiotensin-aldosterone system (RAAS), which is a target for many antihypertensive medications used today. Stress can indirectly influence RAAS activity, leading to increased production of angiotensin II, a potent vasoconstrictor, and secretion of aldosterone, promoting sodium and water retention. These effects collectively contribute to the development and maintenance of hypertension.5  

Antihypertensive Medications  


The management of hypertension has evolved signi cantly, with antihypertensive medications playing a pivotal role. These medications work by lowering blood pressure to reduce the risk of heart disease and stroke.


Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) 

Reduce blood pressure by relaxing blood vessels 


Decrease heart rate and the heart’s output of blood


Commonly known as water pills, work by helping the kidneys to remove excess salt (sodium) and water from the body by reducing blood volume, leading to a decrease in blood pressure

Renin inhibitors 

Directly target renin, an enzyme produced by the kidneys that initiates RAAS

New Therapies in Hypertension Treatment 


Recent advancements in hypertension treatment focus on more targeted mechanisms of action and improved patient compliance. For instance9: 


  • Angiotensin receptor-neprilysin inhibitors (ARNIs) are a novel class of drugs that combine an ARB with a neprilysin inhibitor. Neprilysin is an enzyme that breaks down natriuretic peptides, which help to reduce blood volume and pressure. By inhibiting neprilysin, ARNIs enhance the effects of natriuretic peptides, offering a powerful new approach to blood pressure management. 


Innovative therapies and devices are also under development, aiming to provide long-term solutions for resistant hypertension, such as renal denervation, which uses radiofrequency or ultrasound ablation to reduce sympathetic nerve activity between the kidneys and the brain, showing promising results in lowering blood pressure in patients who do not respond well to conventional medication.10 

The Silent Killer: Stress, Hypertension, and the Quest for Calm
Photo Credit: Peter Kindersley via Centre for Ageing Better

Managing Stress to Control Hypertension 

Effective stress management involves a multifaceted approach, incorporating lifestyle changes, relaxation techniques, and psychological strategies. Here’s how to build a comprehensive stress reduction plan: 


Lifestyle modifications8: 

  • Regular physical activity: exercise serves as a natural stress reliever, promoting the release of endorphins, the body’s natural painkillers and mood elevators. Aim for at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking or cycling, or 75 minutes of vigorous-intensity activity, like running or swimming, per week. 
  • Balanced diet (Dietary Approaches to Stop Hypertension diet): eating a healthy diet can have a profound effect on stress levels. A balanced intake of fruits, vegetables, whole grains, lean protein, and healthy fats is essential. Limit caffeine, sugar, and sodium intake, which can increase stress, anxiety, and blood pressure levels. 

Relaxation techniques4 

  • Deep breathing exercises: deep breathing activates the body’s relaxation response, helping to reduce stress. Techniques such as diaphragmatic breathing, abdominal breathing, and paced respiration can help calm the mind and reduce blood pressure. 

Psychological strategies4: 

  • Cognitive-behavioral therapy (CBT): CBT is a structured, time-limited psychotherapy that helps individuals recognize and alter negative thought patterns and behaviors that contribute to stress. It’s particularly effective in managing stress-related disorders. 



April is recognized as National Stress Awareness Month to bring attention to the negative impact of stress. It is critical to recognize what stress and anxiety look like, take steps to build resilience, and know where to go for help. With advancements in antihypertensive medications and therapies, along with effective stress management strategies, there is hope for those affected. Awareness, education, and proactive management are key to controlling stress and hypertension while leading a healthier life.  


Please see the additional resources available to effectively cope with stress: 



1. American Heart Association. High blood pressure. Accessed March 11, 2024.    


2. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017-2018. NCHS Data Brief. 2020;(364):1-8.   


3. National Institutes of Health. National stress awareness month. Accessed March 11, 2024. 


4. American Psychological Association. Stress effects on the body. Accessed March 11, 2024.,a%20toll%20on%20the%20body.    


5. Navar LG. Physiology: hemodynamics, endothelial function, renin-angiotensin-aldosterone system, sympathetic nervous system. J Am Soc Hypertens. 2014;8(7):519-524.   


6. National Heart, Lung, and Blood Institute. High blood pressure – causes and risk factors. Accessed March 11, 2024.    


7. National Institute on Aging. High blood pressure and older adults. Accessed March 11, 2024.,high%20blood%20pressure%20after%20menopause. 


8. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115.   


9. Ali A, Ortega-Legaspi JM. Is it time to adopt angiotensin receptor-neprilysin inhibitors (ARNI) therapy as standard of care for the management of hypertension? Ann Palliat Med. 2022;11(10):3040-3042.    


10. Fengler K. Renal denervation for resistant hypertension: a concise update on treatment options and the latest clinical evidence. Cardiol Ther. 2022;11(3):385-392.