Emotional Stress as a Risk for Hypertension in Sub-Saharan Africans: Are We Ignoring the Odds?

Abstract

Globally most interventions focus on improving lifestyle habits and treatment regimens to combat hypertension as a non-communicable disease (NCD). However, despite these interventions and improved medical treatments, blood pressure (BP) values are still on the rise and poorly controlled in sub-Saharan Africa (SSA). Other factors contributing to hypertension prevalence, such as chronic emotional stress, might provide some insight for future health policy approaches.Currently, Hypertension Society guidelines do not mention emotional stress as a probable cause for hypertension. Recently the 2014 World Global Health reports, suggested that African governments should consider using World Health Organization hypertension data as a proxy indicator for social well-being. However, the possibility that a stressful life and taxing environmental factors might disturb central neural control of BP regulation has largely been ignored in SSA.Linking emotional stress to vascular dysregulation is therefore one way to investigate increased cardiometabolic challenges, neurotransmitter depletion and disturbed hemodynamics. Disruption of stress response pathways and subsequent changes in lifestyle habits as ways of coping with a stressful life, and as probable cause for hypertension prevalence in SSA, may be included in future preventive measures. We will provide an overview on emotional stress and central neural control of BP and will include also implications thereof for clinical practice in SSA cohorts.

Cultural coping as a risk for depression and hypertension: the SABPA prospective study

“…35 When corporal punishment was abolished in all South African schools, the impact on teachers' morale included loss of control, which may also support the increase in avoidance coping in this teachers' cohort. 4,13,36 Current findings also reflected psychological and cardiovascular vulnerability in the cohort of white teachers, who used consistent spiritual-centred, social support and DefS coping to combat stress.…”

“…29 In our study, chronic stress in blacks was observed and is supported by other studies. 4,13 If combined with chronic higher alcohol consumption, circulatory disturbances such as vasospasms or ischaemic heart disease may ensue. [30][31][32][33][34] Indeed, recent findings in the SABPA cohort showed that habitual utilisation of DefS was often accompanied by alcohol abuse and a profile of reduced coronary perfusion.…”

“…1,2 Recent findings have raised further concern about the rise in incidence of hypertension, a non-communicable disease, globally responsible for an estimated 45% of deaths due to heart disease and 51% of deaths due to stroke, and the seemingly ineffective management of high blood pressure (BP) levels. [3][4][5] Stress coping methods have been studied and analysed for some time, but studies have also identified the need to focus on the influence of culture on coping styles. 6 The devastating health effects of hypertension have also caused an increase in studies, such as this one, that specifically examined the possible link between high BP and differing cultural coping styles.…”

Blood pressure and burden of hypertension in Cameroon, a microcosm of Africa

“…Further research is needed to tease out the distinctive features that predispose people of Bamileke descent to higher BP values and burden of hypertension irrespective of geographic location in Cameroon [42,49,51] and probably in other countries in the world. Such research should be designed to assess epidemiological, genetic, socioeconomic, cultural, behavioral, lifestyle and environmental factors affecting BP levels, hypertension awareness and treatment [83], individual responses to pharmacological therapy [84], emotional stress in sub-Saharan Africans [85] and gene-environment interactions [86].…”

Predictors of Hypertension in a Population of Undergraduate Students in Sierra Leone

“…While we could not find any significant relationship between any of the observed stress categories and blood pressure, others [ 36 ] observed a statistically significant relationship between blood pressure and women with premenstrual syndrome. A recent study has also observed that emotional stress is often ignored as a cause of high blood pressure in SSA [ 37 ]. In a behavioural study of under- and postgraduates in 208 Lagos students (equally split male : female, mean age 20.2), Agbu [ 38 ] found that the female students were more motivated and felt under greater pressure to get things done and find a job.…”