{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T06:36:56Z","timestamp":1769582216517,"version":"3.49.0"},"reference-count":46,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec id=\"S205647242500064X_as1\">\n\t    <jats:title>Background<\/jats:title>\n\t    <jats:p>Noradrenergic activation in the central and peripheral nervous systems is a putative mechanism explaining the link between hypertension and affective disorders.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S205647242500064X_as2\">\n\t    <jats:title>Aims<\/jats:title>\n\t    <jats:p>We investigated whether these stress-sensitive comorbidities may be dependent on basal noradrenergic activity and whether vascular responses to centrally acting stimuli vary according to noradrenergic activity.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S205647242500064X_as3\">\n\t    <jats:title>Method<\/jats:title>\n\t    <jats:p>We examined the relation of affective disorders and stress-mediated vascular responses to plasma concentrations of normetanephrine, a measure of noradrenergic activity, in subjects with primary hypertension (<jats:italic>n<\/jats:italic> = 100, mean \u00b1 s.d. age 43 \u00b1 11 years, 54% male). The questionnaires Patient Health Questionnaire-9 (PHQ-9), 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDSSR-16) and Generalized Anxiety Disorder-7 (GAD-7) were used for evaluation of symptoms of depression and anxiety. Forearm blood flow (strain gauge plethysmography) was used to assess vascular responses to mental stress and to device-guided breathing (DGB), interventions that respectively increase or decrease noradrenergic activity in the prefrontal cortex and locus coeruleus.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S205647242500064X_as4\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>Low mood and high anxiety were two- to threefold higher for hypertensive subjects in the highest compared with the lowest normetanephrine tertiles (each <jats:italic>P<\/jats:italic> &lt; 0.005). Forearm vasodilator responses to mental stress and vasoconstrictor responses to DGB were attenuated in those with high compared with low normetanephrine (28.3 \u00b1 21% <jats:italic>v<\/jats:italic>. 47.1 \u00b1 30% increases for mental stress and 3.7 \u00b1 21% <jats:italic>v<\/jats:italic>. 18.6 \u00b1 15% decreases for DGB for highest versus lowest tertiles of normetanephrine, each <jats:italic>P<\/jats:italic> \u2264 0.01).<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S205647242500064X_as5\">\n\t    <jats:title>Conclusions<\/jats:title>\n\t    <jats:p>A hyperadrenergic state in hypertension is associated with mood disturbance and impaired stress-modulated vasomotor responses. This association may be mediated by chronic stress impinging on pathways regulating central arousal and peripheral sympathetic nerve activity.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1192\/bjo.2025.64","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T04:58:56Z","timestamp":1754888336000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["A hyperadrenergic state in hypertension is associated with depressive symptoms and impaired stress-modulated vasomotor responses: evidence for chronic stress as a common aetiology for a hypertension\/depression phenotype"],"prefix":"10.1192","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1555-0682","authenticated-orcid":false,"given":"Bushra","family":"Farukh","sequence":"first","affiliation":[{"name":"King\u2019s College 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