THE HIDDEN AESTHETIC TOLL OF STRESS

Cardiologist Dr Jay Shah considers how blood pressure monitoring can reveal and reverse the impact of stress

As we grow older, the signs of ageing tend to show up first in the mirror: in our skin, our energy levels and the way we carry stress on our faces and in our bodies. These outward changes often reflect deeper, internal shifts that are just as important to understand.

From my perspective as a cardiologist, the physiological drivers that shape how we age are vastly interesting to delve into – particularly the role of chronic stress and elevated blood pressure. Understanding the link between stress, hypertension and ageing doesn’t just offer a new lens on cardiovascular health, it also opens important conversations about how we support people to age well, both inside and out.

THE LINK BETWEEN STRESS, BLOOD PRESSURE AND AGEING

Stress is, of course, a universal human experience. In the short term, acute stress can be beneficial, triggering the body’s protective “fight or flight” response and sharpening our focus. These short bursts of stress are part of what makes us adaptable and resilient in the face of challenges.

However, the picture changes dramatically when stress becomes chronic or poorly managed. When the stress response is activated repeatedly or sustained over long periods without adequate recovery, it begins to take a measurable toll on the body.

Long-term stress leads to persistent activation of the sympathetic nervous system, raising levels of stress hormones like cortisol and adrenaline. This cascade contributes to elevated blood pressure (hypertension), increased inflammation, impaired immune function and disruption of the body’s natural repair and recovery processes.

Hypertension affects the body on a systemic level. Over time, consistently elevated blood pressure places strain on blood vessels and vital organs such as the heart, kidneys and brain. It reduces the efficiency of circulation and oxygen delivery not only to these essential organs, but to the skin, hair follicles and subcutaneous tissues. This diminished blood flow can impact everything from wound healing and skin regeneration to the delivery of nutrients that support a healthy complexion.

It’s important to recognise that this decline is often gradual and easy to miss in its early stages, but its signs can become increasingly visible: thinning skin, a duller tone, increased puffiness and reduced elasticity – all of which may be exacerbated by poor sleep, hormonal shifts and systemic inflammation.

From a physiological standpoint, it’s clear that stress and elevated blood pressure are not only linked to internal health risks but are also powerful contributors to the external signs of ageing. They are part of a broader continuum, where what’s happening beneath the surface eventually reveals itself in how we look and feel.

THE AESTHETIC IMPLICATIONS OF STRESS AND HYPERTENSION

Fine lines, wrinkles, dull or dry skin, puffiness, changes in weight distribution and dark circles under the eyes are all common manifestations of chronic stress. These signs may creep in gradually as stress begins to affect circulation, disrupt hormonal balance, interfere with sleep and impair the body’s natural repair mechanisms. Hair may lose its fullness or sheen, skin may become less elastic and general energy levels can decline, all contributing to a look and feel that’s older than one’s biological age.

Although signs like tired eyes or prematurely ageing skin are not uncommon in clinical practice, they present an opportunity: a chance to explore whether these symptoms point to something broader. Looking beneath the surface can help guide patients toward more comprehensive health and well-being strategies.

This is where blood pressure monitoring offers unique value. While skin appearance is influenced by a mix of genetics, environment and lifestyle, blood pressure is a quantifiable, real-time marker of how the body is responding to stress at any given moment. It helps uncover physiological trends that are otherwise invisible – especially in patients who may not report obvious symptoms, but whose readings reveal underlying strain that could be contributing to how they look and feel.

BLOOD PRESSURE MONITORING AS AN INDICATOR OF STRESS

By tracking blood pressure patterns over time, individuals can start to build a clearer picture of how their body is handling the demands of daily life. For instance, consistently elevated readings during periods of rest or sleep, when blood pressure should naturally dip, can signal that stress, poor recovery or underlying health conditions are at play.

Sleep disturbances caused by stress or conditions like sleep apnea not only leave individuals feeling fatigued but can also accelerate visible signs of ageing through impaired cellular repair, reduced skin regeneration and increased inflammation. In this way, regular blood pressure monitoring can act as an early warning system – helping to identify these patterns and encouraging timely lifestyle changes that benefit both health and appearance.

Moreover, tracking blood pressure isn’t only about identifying problems – it also offers an opportunity to celebrate progress. Watching blood pressure trends improve over time with better stress management or lifestyle changes can be a highly motivating and empowering experience for patients.

Importantly, it also provides practitioners with a concrete, data-driven way to engage patients in their broader health journey. This kind of objective feedback can strengthen trust, reinforce adherence to wellness recommendations and help patients take greater ownership of their long-term health goals.

EMPOWERING INDIVIDUALS THROUGH STRESS MANAGEMENT

Unlike many health conditions that rely solely on medical intervention, stress is an area where individuals can play an active and empowered role in improving their well-being.

While more severe cases of stress or anxiety should always be managed in partnership with a medical professional, particularly when prescription medication or more intensive therapies are needed, many people can make meaningful progress through lifestyle-based interventions.

This is a particularly positive and encouraging message to share with patients. While not every aspect of ageing is within our control, managing stress is an area where small, consistent actions can have a profound impact, and where measurable improvements are possible at any age.

Practices such as mindfulness, meditation, breathwork, regular exercise, quality nutrition and prioritising sleep have all been shown to support stress reduction. Even simple actions, such as spending time in nature, setting healthy boundaries with technology, or cultivating social connection, can play a role.

The beauty of incorporating blood pressure monitoring into this journey is that it provides individuals with tangible, real-world feedback on how these interventions are impacting their body.

Seeing a pattern of lowered blood pressure readings after adopting stress-management techniques can be highly motivating, providing reassurance that their efforts are making a measurable difference. In this way, blood pressure monitoring becomes more than just a clinical tool, but rather a means of fostering self-awareness, encouraging healthier behaviours and ultimately supporting both cardiovascular health and aesthetic outcomes.

A SUBTLE BUT POWERFUL TOOL FOR PRACTITIONERS TO RECOMMEND

For practitioners who are increasingly adopting a more holistic, well-being-oriented approach to patient care, encouraging patients to proactively monitor their blood pressure offers a unique opportunity.

Devices like the Hilo Band, for example, allow for 24/7 cuffless blood pressure monitoring, offering individuals a convenient way to track their readings throughout daily life and gain valuable insights into how stress, lifestyle choices and health interventions are affecting their cardiovascular function.

While not a treatment, blood pressure monitoring is a powerful addition to the toolkit of health optimisation. It provides both patients and practitioners with an objective measure that bridges the gap between internal health and external appearance, supporting longer-term strategies for ageing well, both inside and out.

By integrating this kind of proactive monitoring into aesthetic care, practitioners can help patients better understand the connection between their lifestyle choices, internal health and external appearance.

DR JAY SHAH

Dr Jay Shah MD FACC is the chief medical officer at Hilo and has deep leadership expertise across healthcare delivery, leadership, and innovation. Dr Shah studied medicine at the University of Missouri-Kanas City School of Medicine and then completed a residency in Internal Medicine at Massachusetts General Hospital, followed by a fellowship in cardiovascular diseases at the Washington University School of Medicine.