Impact of psychoemotional stress and physical activity on endothelial function in hypertensive patients with obesity

Objective. To study the effect of chronic emotional stress and physical activity on endothelial function in patients with arterial hypertension (HTN) and obesity.

Design and methods. We enrolled 76 male patients with HTN stage I and II. Group 1 consisted of 36 patients with HTN and obesity, group 2–40 hypertensive patients without obesity. Ultrasound of the brachial artery was performed to assess endothelial function after reactive hyperemia (flow-mediated dilation) and nitrate administration (nitrate-mediated dilation). Serum cortisol level was determined by enzyme-linked immunosorbent assay. PSM‑25 scale was used to access psycho-emotional stress. The level of reactive and personal anxiety was measured by the Spielberger and Khanin’s questionnaire. Brief international physical activity questionnaire was used (IPAQ) for physical activity evaluation.

Results. In patients with HTN and obesity a more significant deterioration of the flow-mediated and nitrate-mediated dilation (FMD and NMD) was found compared to hypertensive patients without obesity, and to healthy individuals. In both groups physically inactive patients showed a significant decrease in endothelial function compared to physically active patients. In group 1, an inverse correlation between FMD with the level of reactive anxiety and trait anxiety (r = –0,54; r = –0,46, respectively; p < 0,05) and a direct correlation with the level of physical activity (r = 0,42; p = 0,01) was found. In group 2, FMD and NMD inversely correlated with psycho-emotional stress (r = –0,42; r = –0,33, respectively; p < 0,05) and directly correlated with the level of physical activity (r = 0,46; r = 0,33, respectively; p < 0,05). In both groups, there were direct correlations between cortisol levels with personal and reactive anxiety scores. Furthermore, there was an inverse association between FMD and cortisol levels in group 1 (r = –0,36; p = 0,05) and group 2 (r = –0,41; p = 0,02).

Conclusions. Our findings suggest a strong connection between chronic emotional stress and physical inactivity with endothelial dysfunction in hypertensive patients.

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