Environmental and Psychosocial Factors in Hypertension: An Emerging Landscape of Cardiovascular Risk
Year: 2026
Type: review
Abstract: Environmental and psychosocial factors are increasingly recognized as important contributors to the development, progression, and control of hypertension (HTN) and cardiovascular (CV) disease. Within the exposome framework, these exposures converge on shared neuroendocrine, oxidative, and inflammatory pathways leading to endothelial dysfunction and blood pressure (BP) elevation. Among environmental pollutants, air pollution, particularly fine particulate matter (PM2.5), is a major modifiable risk factor; each 10 µg/m³ increase in PM2.5 is associated with a 4% rise in HTN prevalence. Transportation noise from road traffic and aircraft independently increases HTN risk through stress-related neurohormonal activation, oxidative stress, and sleep disruption. Artificial light at night and heavy metals are additional contributors, whereas micro- and nanoplastics remain an emerging concern awaiting robust human data. Physical and climatic stressors also influence BP regulation. Both heat and cold are associated with increased CV morbidity and mortality, with cold exerting the greater impact, and hypobaric hypoxia at high altitude activates sympathetic and neurohormonal pathways that promote BP elevation, particularly in hypertensive individuals. Among psychosocial and behavioral factors, sleep disturbances, including obstructive sleep apnea, short sleep duration, and poor sleep quality, are associated with incident and resistant HTN. Post-traumatic stress disorder (PTSD) is an underrecognized determinant of HTN, especially among refugees, migrants, war veterans, and other trauma-exposed populations, through chronic sympathetic activation, inflammation, and adverse behavioral pathways. Finally, spaceflight provides a unique model of extreme environmental stress, inducing CV adaptations ranging from transient BP dysregulation and orthostatic intolerance to vascular remodeling resembling accelerated CV aging. Recognizing these determinants is essential to improve HTN prevention, optimize BP control, and reduce long-term CV risk.
Source: Blood Pressure
Authors: Thierry DENOLLE, Nicole GEBARA, Julien BERTOLINO, Karen BACHETTI, Jean Philippe BAGUET, Jean Marc BOIVIN, Pierre BOUTOUYRIE, Audrey DEROBERTMASURE, Anne-Sophie EVRARD, Guillaume LAMIRAULT, Marilucy LOPEZ-SUBLET, Alexandre PERSU, Eric RENAUDINEAU, Philippe SOSNER, Maria Simona STOENOIU, Bernard VAISSE, Béatrice DULY BOUHANICK
Institutions: Hôpital Broussais, Saint Joseph University, Hôtel-Dieu de France, Hôpital de la Timone, Inserm, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris Cardiovascular Research Center, Université de Lorraine, Université de Lyon, Université Gustave Eiffel, Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement, Centre National de la Recherche Scientifique, Institut du Thorax, Nantes Université, Hôpital Avicenne, Marqueurs cardiovasculaires en situation de stress, Cliniques Universitaires Saint-Luc, UCLouvain, KU Leuven, Hôtel-Dieu de Paris, Institut National du Sport, de l'Expertise et de la Performance, Hôpital Rangueil, Université de Toulouse
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,650
OpenAlex ID: W7224129273