Hypertension and psychosocial factors: which came first, the egg or the chicken?

In this issue of the Journal of Geriatric Cardiology, the article of Yu, et al1 presents an intriguing issue in the field of hypertension treatment and pathophysiology. On one hand, it appears quite logical that social and psychological stresses may lead to a hypertensive status which increase all those physiological neuro-hormonal responses to stress, on the other hand, however, it seems similarly intuitive that poor social status and low familial support decrease the chance that patients are compliant with assigned therapy. It appears more difficult to understand where one begins and the other finishes or, in other words, which is the first phenomenon to start; the old Italian, probably worldwide-question “which came first: the egg or the chicken?” is very hard to answer. In his article, Yu and colleagues studied a small cohort of patients with hypertension and tried to discriminate the therapeutic response on the basis of psychosocial factors. The patients were whitecollar professionals with probably a quite good economic status, which in itself is a positive social factor. They did not have any disease other than hypertension, which is another positive “anti-stress” factor. Despite these limitations, patients with lower response to therapy are those with higher stressful, anxiety, and depressive scores.