A large-scale study of stress, emotions, and blood pressure in daily life using a digital platform

Proc Natl Acad Sci U S A. 2021 Aug 3;118(31):e2105573118. doi: 10.1073/pnas.2105573118.


Stress is often associated with pathophysiologic responses, like blood pressure (BP) reactivity, which when experienced repeatedly may be one pathway through which stress leads to poor physical health. Previous laboratory and field studies linking stress to physiological measures are limited by small samples, narrow demographics, and artificial stress manipulations, whereas large-scale studies often do not capture measures like BP reactivity in daily life. We examined perceived stress, emotions, heart rate, and BP during daily life using a 3-wk app-based study. We confirmed the validity of a smartphone-based optic sensor to measure BP and then analyzed data from more than 330,000 daily responses from over 20,000 people. Stress was conceptualized as the ratio of situational demands relative to individual resources to cope. We found that greater demands were associated with higher BP reactivity, but critically, the ratio of demands relative to resources improved prediction of BP changes. When demands were higher and resources were lower, there was higher BP reactivity. Additionally, older adults showed greater concordance between self-reported stress and physiologic responses than younger adults. We also observed that physiologic reactivity was associated with current emotional state, and both valence and arousal mattered. For example, BP increased with high-arousal negative emotions (e.g., anger) and decreased with low-arousal positive emotions (e.g., contentment). Taken together, this work underscores the potential for expanding stress science and public health data using handheld phones to reliably and validly measure physiologic responses linked to stress, emotion, and physical health.

Keywords: EMA; blood pressure; digital platforms; emotions; stress.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Pressure*
  • Emotions*
  • Female
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic*
  • Reproducibility of Results
  • Stress, Physiological*
  • Young Adult