Self-Perceived Psychological Stress and Risk of First Stroke in Treated Hypertensive Patients.

Di Xie, Guobao Wang, Min Liang, Chengzhang Liu, Tengfei Lin, Yuanyuan Zhang, Panpan He, Huan Li, Lishun Liu, Yun Song, Jianping Li, Jing Nie, Fan Fan Hou, Binyan Wang, Xianhui Qin, Yan Zhang, Yong Huo, Xiping Xu, Xiaobin Wang

Journal: Psychosomatic medicine 2022;84(2):237-243

PMID: 34654026

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Abstract

OBJECTIVE

We aimed to investigate the prospective association between self-perceived psychological stress and first stroke, and to examine possible effect modifiers among adults with hypertension.

METHODS

A total of 20,688 hypertensive adults with information on self-perceived psychological stress at baseline were included from the China Stroke Primary Prevention Trial. Participants were randomly assigned to a double-blind treatment of receiving a single tablet daily with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. Follow-up visits occurred every 3 months after randomization. Psychological stress was measured with a one-item 3-point rating scale. The primary outcome was first stroke (fatal or nonfatal).

RESULTS

The median treatment period was 4.5 years. Compared with participants with low levels of psychological stress, those with high psychological stress had a significantly higher risk of first stroke (adjusted hazard ratio = 1.40, 95% confidence interval = 1.01 to 1.94) or first ischemic stroke (adjusted hazard ratio = 1.45; 95% confidence interval = 1.01 to 2.09). Moreover, a stronger positive relationship between psychological stress and first stroke was found in participants with time-averaged mean arterial pressure <101 mm Hg (median; p-interaction = .004) during the treatment period. However, our study did not find a significant association between psychological stress and first hemorrhagic stroke.

CONCLUSIONS

Higher psychological stress was associated with an increased risk of first stroke among treated hypertensive patients, especially in those with lower mean arterial pressure during the treatment period.

Address: From the Division of Nephrology, Nanfang Hospital, Southern Medical University (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin); National Clinical Research Center for Kidney Disease (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin); State Key Laboratory of Organ Failure Research (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin); Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin); Guangdong Provincial Clinical Research Center for Kidney Disease (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin), Guangzhou; Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing (Lin, Song, Liu, Xu); Institute of Biomedicine, Anhui Medical University, Hefei (Liu, Wang, Qin); Shenzhen Evergreen Medical Institute, Shenzhen (Liu, Song, Wang); Department of Cardiology, Peking University First Hospital, Beijing (Zhang, Li, Huo); and Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (Wang).

DOI: 10.1097/PSY.0000000000001030

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MeSH Terms: Adult, Antihypertensive Agents, China, Double-Blind Method, Enalapril, Humans, Hypertension, Stress, Psychological, Stroke