Inoue K, Horwich T, Bhatnagar R, et al. - An elevated risk of incident hypertension was observed in relation to higher urinary stress hormone levels in this multiethnic population study. An association of urinary cortisol levels with an increased risk of incident cardiovascular events was also identified. Thus, stress hormones have a potentially vital role in the prevention as well as treatment of hypertension and cardiovascular diseases.

• Psychosocial stress majorly contributes to the pathogenesis of hypertension and cardiovascular disease.

• This is a prospective cohort study with 412 adults (age 48–87 years) free of hypertension from the Multi-Ethnic Study of Atherosclerosis.

• An elevated risk of incident hypertension was observed per doubling of norepinephrine [adjusted hazard ratio (aHR), 1.31], epinephrine (aHR, 1.21), dopamine (aHR, 1.28), and cortisol (aHR, 1.23).

• The links were generally stronger in participants <60 years vs those ≥60 years, especially for dopamine and cortisol.

• An elevated risk of incident cardiovascular events was noted per doubling of cortisol (aHR, 1.90), but not for catecholamines.