Borderline hypertensives produce exaggerated adrenocortical responses to mental stress.

Serum cortisol concentrations were compared in 18 borderline hypertensive (BH) and 20 normotensive (NT) men before and after mental stress. Two levels of demand, intermittent reaction time with brief rests and reaction time alternating continuously with mental arithmetic, were used in two consecutive protocols on different days in the laboratory. Continuous, but not intermittent, mental stress produced significant elevations in cortisol levels only in the BH subjects (p < .001). The continuous challenge produced slightly more self-reported distress in both groups than the intermittent condition, and performance on the mental arithmetic task was more strongly correlated with the cortisol response than was performance on the reaction time task, suggesting that the mental arithmetic task was a key contributor to the cortisol response. Therefore, adrenocortical activity appears sensitive to appropriate stressors in BH subjects. These results indicate the importance of including measures of adrenocortical function in studies of reactivity in subjects at high risk for hypertension.