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International Journal of Hypertension
Volume 2012, Article ID 453465, 9 pages
Review Article

Rumination as a Mediator of Chronic Stress Effects on Hypertension: A Causal Model

1Department of Biobehavioral Health, The Pennsylvania State University, 315 HHD East, University Park, PA 16802, USA
2Clinical Health and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
3Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
4Department of Psychology, University of California San Diego, La Jolla, CA 92093, USA
5Department of Psychology, University of Calgary, Calgary, AB, Canada T2N 1N4

Received 4 September 2011; Accepted 14 November 2011

Academic Editor: Simon L. Bacon

Copyright © 2012 William Gerin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Chronic stress has been linked to hypertension, but the underlying mechanisms remain poorly specified. We suggest that chronic stress poses a risk for hypertension through repeated occurrence of acute stressors (often stemming from the chronic stress context) that cause activation of stress-mediating physiological systems. Previous models have often focused on the magnitude of the acute physiological response as a risk factor; we attempt to extend this to address the issue of duration of exposure. Key to our model is the notion that these acute stressors can emerge not only in response to stressors present in the environment, but also to mental representations of those (or other) stressors. Consequently, although the experience of any given stressor may be brief, a stressor often results in a constellation of negative cognitions and emotions that form a mental representation of the stressor. Ruminating about this mental representation of the stressful event can cause autonomic activation similar to that observed in response to the original incident, and may occur and persist long after the event itself has ended. Thus, rumination helps explain how chronic stress causes repeated (acute) activation of one’s stress-mediating physiological systems, the effects of which accumulate over time, resulting in hypertension risk.