The document discusses Hill's criteria for establishing a causal relationship between stress and hypertension. It outlines the 9 criteria including biological plausibility, dose-response relationship, strength of association, study design, reversibility, temporality, consistency, and plausibility. Research from the United States found that individuals with high perceived stress were 61% more likely to have hypertension. Studies from India also found odds ratios above 1, indicating increased risk of hypertension due to stress.

1. Universal medical and bussiness college
Department of clinical pharmacy
Pharmacoepidemology
Group members
1)Edom biruk 187/12
2)Emebet andargie 189/12
3) mahder
4)samuel
Submitted to:Ms ewnet

2. Question
*Hills criterion to establish causation between stress
and hypertension
INTRODUCTION
-HYPERTENSION:-is blood pressure that is higher
than normal .
-stress:-is either psychological,biological or
physiological is an organisms response to a stressor
such as an environmental condition.
*Hill's criteria to evaluate the association b/n stress
and hypertension

3. 1)BIOLOGICAL PLAUSIBILITY: stress can cause
hypertension through repeated blood pressure
elevations as well as stimulation of the nervous
system to produce large amounts of vasoconstricting
hormones.
2)DOSE RESPONSE RELATIONSHIP: Suggests that as
the level of stress increases,the risk of the
hypertension also increases .
3)STRENGTH OF ASSOCIATION: Strength of
association is more likely to indicate a causal
relationship than is a modest or weak association.
The chronic stress and hypertension odds ratio has
found to be greater than 1 in many studies.

4. 4) STUDY DESIGN : research suggest that chronic
stress contributes to high blood pressure.
5) REVERSIBILITY: Stress induced hypertension when
stress goes away,blood pressure returns to what it
was before the stress.
6)TEMPORALITY : Refers to temporal sequence of
events where the stress procedes/comes up with the
hypertension. Tho it doesn't happens everytime!

5. 7)CONSISTENCY: Among different studies
/populations consistently reported positive
association between stress & hypertension.
8)PLAUSIBILITY :For both general and specific
causation refers to the degree to which the observed
association can be explained by known scientific
principles.
Results : United states reasearch shows
Hypertension prevalence was 29.1% individuals with
high perceived stress were 61% more likely to have
hypertension .
*The increasing burden of hypertension due to stress
among states of india.odds ration (1.198,95%)

6. • Reference
• 1)https://www.google.com/url?sa=t&source=web&
rct=j&opi=89978449&url=https://health.ec.europa.
eu/eu-health-policy/interest-groups/eu-health-
award/2021-eu-health-award-
criteria_en&ved=2ahUKEwjZ3Y787_H_AhWwg_0H
Hb87CJ0QFnoECBsQAQ&usg=AOvVaw0evi13HV2ag
-7vNCnrSxpu3
• 2).www.frontersin .org4.
• 3)http://www.oxford reference. Com