Under Pressure How Stress Impacts Heart Health, and What to Do About It

A little stress can be a good thing, says Dr. George Abbott. Beyond that? Not so much.

“You have to distinguish between momentary stress and chronic, repeated stress,” said Abbott, clinical and counseling psychologist at Holyoke Medical Center.

“On the physical level, a little bit of stress at any given moment in time contributes to a rise in blood pressure, which helps to oxygenate the muscles and organs of the body. And that helps you deal with the short-term stress, whether it’s by fighting or taking flight or thinking fast. Having more oxygen in you can be a helpful thing.”

However, he continued, that’s no way to spend every waking moment.

“The problem comes when stress is going on chronically, and a person never gets to recover from it,” he said. “Then you develop a new set point for blood pressure, and instead of it being momentarily high, it just ends up being high all the time, and that’s very destructive to the body. It causes the heart to beat faster all the time, and that’s going to wear out the heart.”

That’s bad news for a culture that seems to pile on the stress. Still, the relationship between stress and heart health can be difficult to quantify, said Dr. Marc Schweiger, director of the Cardiac Catheterization Laboratories at Baystate Medical Center and also its director of Cardiology Research and its Interventional Cardiology Fellowship Program.

“You have certain people who will come in and say, ‘I have a lot of stress,’ or, ‘you know, I had my heart attack because I was under a lot of stress,’” he said. “But, of course, a lot of people who are under a lot of stress don’t have heart attacks, so the relationship between the two is often hard to get your arm around.”

For this month’s focus on cardiovascular health, The Healthcare News examines how stress and the heart are related, and how people can find ways to reduce some of the risks to their physical and mental well-being.

Ups and Downs

To use a metaphor, Abbott compared the nervous system to a seesaw. When someone is in an alerted state, muscle tension, respiration, and blood pressure go up, and in calmer circumstances, all those functions cycle down. In fact, he said, even absent obvious stressors, the two conditions tend to subtly alternate throughout the day.

“When those things get stimulated under stress, they prepare you to react and respond to problems,” he noted. “But with chronic stress, you get locked into that one position, and your body doesn’t get the chance to gently oscillate back and forth. So you’re no longer dealing with stress; you’re dealing with the effects of stress.”

And those effects are not just physical, he explained.

“When people are stressed, very often their level of mental functioning is reduced,” Abbott said. “They don’t think things through well, and they’re more prone to making errors and bad judgments. They tend to do, shall we say, unskillful things. They tend to react to certain situations poorly.

As an example, he continued, “someone who is highly stressed may, with lowered mental levels, resort to actions like stuffing themselves with junk food. They’re not thinking about it; they’re just doing it, and that’s not a very effective way to get nutrition. That’s what we call a substitute action, something that someone does when their mental level is low as a result of excessive stress, and that’s not a good way of accomplishing goals.”

Schweiger noted that the major risk factors for cardiovascular disease, heart attacks, and strokes include smoking, high cholesterol, diabetes, hypertension, family history, obesity, and so on — some modifiable, some less so.

“If people who feel stress are more likely to smoke because they feel anxious,” he said, “then, yes, stress can contribute to those behaviors.”

But he was careful not to draw too clear a line between mind and body when it comes to heart health. “People with known coronary disease who are depressed appear to do worse,” he said, “but it’s often hard to tease out whether they’re depressed because they feel lousy from heart disease. I think it’s difficult to quantify.”

The key, he said, is for people with a combination of stress and poor habits, like smoking or eating an unhealthy diet, not to ignore those issues that are proven cardiovascular dangers when weighing the role of stress. “Don’t overlook the things we absolutely know that, if we correct them, we can decrease the risk.”

Schweiger cited several theories related to stress which are still under consideration in the scientific community. “There is some data — although not everyone buys it — that says a type A personality, who has a more high-strung, exacting personality, is more likely to have blood-vessel disease than people who are not as goal-oriented and specifics-oriented,” he said. “But I think a lot of people would pooh-pooh that.”

In addition, “certainly there are some data suggesting that particular factors, such as bereavement, loss of job, or depression, may have a relationship to end points such as heart attacks,” Schweiger said.

Abbott noted that researchers are uncovering new, long-term effects of stress in older people, including the revelation that chronic high blood pressure might be a strong risk factor for dementia.

“When you take a look at the brains of people who have died with dementia, you’ll find an increased number of lesions in the white matter of the brain, and that corresponds to chronic high blood pressure,” he explained.

“Elderly people who pass away with dementia have more lesions on the brain than those without dementia, and those with higher blood pressure have more lesions on the brain than those without higher blood pressure.” That traces at least one connection, he said, between body and mind in terms of blood pressure and, by extension, stress.

Weight of the World

And how does that stress develop in the first place? Abbott listed several factors that contribute to chronic stress, from the sagging economy to the very act of living in an urban environment, in close proximity to many other people.

“The World Health Organization published a map several years ago which plotted the incidence of chronic hypertension around the world,” he told The Healthcare News. “You saw dark-colored dots wherever there was incidence of high blood pressure, and then these dots came together to make big, dark areas where there’s a lot of chronic high blood pressure. In rural areas, you see very little, and in any sort of suburban or exurban area, you find an increased amount. But when you go into the urban areas, that’s where you see the biggest, darkest blotches.

“It’s not a mystery,” he continued, “when people living in close proximity are making adjustments for other people’s actions all the time, that’s very stressful. From coping with traffic in the city every morning to the noise and harsh lighting and so forth, these can all cause high blood pressure.”

Fortunately, people have almost unlimited options for activities that promote stress reduction, if they just set aside the time for them.

“All of them basically involve taking time away from the things you normally do, situations that normally expose you to stress,” Abbott said. “You can try walks in the park, going for a swim, listening to music, reading poetry, going to the beach, hanging out with friends … these are all good things to do.

“Then there’s tai chi, yoga, qi gong — things that require slowing and relaxing the body, but they’re things that are very sociable, allowing you to be with other people in a fun way,” he continued. “It’s also very beneficial and relaxing to spend time with a pet.”

For those who want to explore what Abbott called “deeper recovery,” prayer and meditation are also options. “We have a lot of research showing that meditation lowers blood pressure,” he said, “and people who meditate every day stand a very good chance of lowering their blood pressure into the normal ranges. That’s not going to be true for every case, but it is predominantly true.”

But whatever the activity, “you have to do something on a regular basis, which means daily,” he emphasized. “The real power in these activities lies in the continuity of their use, and when you do it every day, you’re giving your body a chance to recover and repair some of the damage.”

In fact, Abbott explained, studies have shown that many of these activities provide more of a healing relaxation for the body than sleeping — sometimes twice as much.

“When you’re stressed and rattled, you might lie down and wake up feeling like you didn’t sleep at all,” he said. “You might be fitful in your sleep or have bad dreams, tossing and turning. So sleep itself is not necessarily as useful as really focusing your mind on a relaxing activity while you’re awake. You need daily participation in some technique that focuses you and focuses your heart rate.”

Stress reduction varies from person to person, Schweiger said, yet the focus, when talking about cardiovascular health, should remain on eliminating obviously damaging habits, like smoking.

Still, “a colleague of mine thinks tai chi is terrific,” he noted. “And for some people, stress-reduction programs can sometimes lower blood pressure. Exercise and stress reduction are good goals, if for no other reason, because, when we do those things, we feel better.”

And that’s the heart of the matter.