Mechanistic Links Between Chronic Psychological Stress and Hypertension: Evidence from Working Adults in Aba, Abia State

The physiological mechanisms linking chronic occupational stress to sustained blood pressure elevation remain an active area of investigation, particularly in low-income and middle-income country work contexts. This study examined the mechanistic relationships between chronic psychological stress and hypertension in working adults in Aba, Abia State, South East Nigeria. A cross-sectional analytical design recruited 100 employed adults aged 25 to 55 years. Psychological stress was quantified using the Perceived Stress Scale. Ambulatory blood pressure monitoring was conducted over 24 hours to capture daytime, nighttime, and mean arterial pressure. Salivary cortisol was collected at four time points across one day. Serum catecholamine metabolites and high-sensitivity C-reactive protein were assayed as sympathetic and inflammatory mediators. Structural equation modelling and regression analyses were applied. Results showed that high perceived stress scores predicted elevated 24-hour mean arterial pressure significantly, mediated by elevated cortisol and sympathetic activation indices. Blunted nocturnal blood pressure dipping was significantly more common among high-stress participants. High-sensitivity C-reactive protein mediated approximately 20 percent of the stress-blood pressure relationship. This study provides mechanistic evidence linking psychosocial stress to hypertension through neuroendocrine and inflammatory pathways in a Nigerian workforce, filling an important gap. Stress reduction programmes and cortisol-conscious hypertension management are recommended. Keywords: psychological stress, hypertension, cortisol, sympathetic activation, Aba.