Stress, coping, lifestyle and hypertension: a paradigm for research, prevention and non-pharmacological management of hypertension.

Lifestyle related factors such as obesity, drinking habits, sodium and potassium intake and physical inactivity are well established determinants of high blood pressure. The role of psycho-social stressors, and in particular environmental work or home stress is far less clear. Some but not all studies using the Karasek 'job-strain' model have found a relationship with ambulatory blood pressure levels. Other studies using more 'subjective' measures of occupational stress have found no relationship or even inverse associations with blood pressure. The possibility that relationships between external stressors, personality factors and blood pressure levels might be mediated or confounded by coping mechanisms influencing lifestyle factors known to directly affect blood pressure has not been adequately studied. This paper briefly explores the paradigm relating environmental psychosocial stress, individual coping mechanisms, lifestyle behaviours and blood pressure levels. The issues are critical for research methodology in this area and for the development of better behavioural strategies for the prevention and nonpharmacological management of hypertension.