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

• Published in: Psychosomatic medicine 2022-02, Vol.84 (2), p.237-243
• Main Authors: Li, Huan, He, Panpan, Zhang, Yuanyuan, Lin, Tengfei, Liu, Chengzhang, Xie, Di, Liang, Min, Wang, Guobao, Nie, Jing, Song, Yun, Liu, Lishun, Wang, Binyan, Zhang, Yan, Li, Jianping, Huo, Yong, Wang, Xiaobin, Hou, Fan Fan, Xu, Xiping, Qin, Xianhui
• Format: Article
• Language: English
• Subjects: Adult; Antihypertensive Agents - therapeutic use; China; Double-Blind Method; Enalapril; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - epidemiology; Stress, Psychological - complications; Stroke - etiology
• ISSN: 0033-3174; 1534-7796
• DOI: 10.1097/PSY.0000000000001030

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. 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). 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