ABC | Volume 113, Nº3, September 2019

Original Article Dalmazo e al. Stress in hypertension Arq Bras Cardiol. 2019; 113(3):374-380 on the scalp, avoiding contact only on the hair. Weight and height data were used to calculate body mass index (BMI) and the following cutoff points were used for adults: Low weight < 18.5 kg/m 2 ; Eutrophic 18.5 - 24.9 kg/m 2 ; Overweight 25 - 29.9 kg/m 2 and Obesity ≥ 30 kg/m 2 ; 3 and for elderly: Low weight: < 22 kg/m 2 ; Eutrophic: 22 - 27 kg/m 2 and Excess weight:> 27 kg/m² according to Lipschitz (1994). 13 For the qualitative evaluation of food consumption, food frequency questionnaire adapted from Ribeiro et al., 14 was applied in order to analyze the frequency of food consumption. The interpretation of this questionnaire was carried out through the stratification of the consumed food groups, being evaluated the following groups: ultra-processed foods, in natura foods, rich in carbohydrates, proteins and lipids. Lipp's stress symptoms inventory (LSSI) for adults was applied by a psychologist to evaluate the symptoms of stress. This inventory is an objective measure of stress symptomatology in individuals over 15 years of age. LSSI is composed of 37 somatic and 19 psychological items whose symptoms, if repeated, differ only in intensity and severity. This instrument is divided into 3 sets: the 1st with 15 items refers to the physical or psychological symptoms that the patient has experienced in the last 24 hours; the second, composed of ten physical and five psychological symptoms, and is related to the symptoms experienced in the previous week; the third, with 12 physical and 11 psychological symptoms, refer to the situation of the previous month. 15 Statistical analysis Data tabulation was performed in the Microsoft Excel 2013 for Windows. The statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 22.0. Variables with normal distribution were described in mean ± standard deviation. Variables with normal distribution were described in mean ± standard deviation and variables with asymmetric distributions such as median and interquartile range (25th and 75th percentile). In order to correlate dietary intake of different food groups (carbohydrates, lipids, proteins, in natura and ultra-processed foods) with the stress phases, the Spearman correlation coefficient was used. For the comparison of continuous variables concerning the presence or absence of stress, the Mann-Whitney test (food intake) and Student's t-test (blood pressure) were used for independent samples. In regards to the types of stress symptoms (physical/psychological/mixed) the tests used were Kruskal Wallis (food consumption) and ANOVA One-way (blood pressure). Significance level of 5% (p < 0.05) was considered. Results The sample consisted of 100 patients with a mean age of 55.87±12.55 years and 67% (n=67) were females. Themean values of blood pressure were 182.38 ± 28.01 mmHg for systolic and 94.95 ± 12.42 mmHg for diastolic. Regarding the stress variable, 86% (n = 86) of the participants were included in some of the phases, of which 57% were in the resistance phase (Table 1). No correlation was observed between the different stages of stress, blood pressure and food consumption (Table 2). Table 3 shows the comparison of the food consumption profile with the presence or absence of stress and blood pressure. Among the food groups investigated, there was a significant association with foods rich in lipids and psychological symptoms of stress, according to Table 4. Discussion This study aimed to describe the relationship between stress and food consumption in hypertensive patients. Analyzing the consumption of foods rich in lipids in individuals with stress and predominance of psychological symptoms, we found a significant association between the variables. Regarding the predominance of women, it is believed that a more significant number of them seek care assistance and show higher health concerns when compared to the men. 16 In a review of stress-induced eating, Greeno and Wing 17 have shown that different stress stimuli cause different reactions, taking into account the individuality of the patients, but stress can affect the quality of food choice. Nguyen et al. 18 demonstrated in his study on stress-induced eating with 517 students that perceived stress was a significant correlate of "emotional eating" and also added in their results that this factor is independent of BMI, suggesting there is no relation between stress-induced eating; and people who are overweight and obese. In the present study, we did not observe a significant positive relationship between food consumption in different stages of stress with the presence or absence of stress. The divergences found in this study concerning those mentioned above can be attributed to the diversity of the analyzed variables, which suggests a more detailed investigation, as it is well documented by Sousa et al. 19 that the stimuli and physiological responses differ in each phase of the stress. 19 Regarding stress, in the resistance phase (57%), it is in agreement with the results obtained by Wottrich et al., 20 in which the predominance of the individuals evaluated was predominant in the endurance phase. These findings are in agreement with data from the study described by Malagris 21 and Rosseti 22 whose results were similar in their research. Lipp et al. 23 also emphasizes that the resistance phase is associated with excessive fatigue, memory problems and doubts about oneself, which can significantly compromise the individual's quality of life. Pecoraro et al. 24 and Zellner et al. 25 stated that in order to minimize stress symptoms, it is common to eat tasty foods, mostly high in fat, as a form of comfort and "self-medication". In another study with adolescents conducted in London, it was found that a high degree of perceived stress was related to high intakes of fat and large amounts of unhealthy meals. 5 In this study, a positive association between the consumption of rich foods in lipids in patients classified with some level of stress, with a predominance of psychological symptoms. 5 It is important to point out that fat in the food promotes greater palatability being also more caloric. The fact that 376