Perceived Stress as a Mediator between Episodic and Semantic Memory in Hypertensive and Normotensive Individuals: A Neuropsychological Perspective

Abstract

Background: Hypertension is not only a leading cardiovascular risk factor but also significantly influences cognitive functioning, particularly episodic and semantic memory. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to heightened perceived stress, has been linked to neurocognitive impairments. Despite growing evidence, the interplay between episodic memory, perceived stress, and semantic memory remains underexplored, particularly in hypertensive populations

Method: This cross-sectional, comparative study included 200 participants (100 hypertensive, 100 normotensive), recruited through purposive sampling. Data collection occurred between October 1, 2024, and January 4, 2025, at the Cognitive and Neuroscience Lab, Foundation University School of Science and Technology (FUSST), and the Cardiology Department at Fauji Foundation Hospital, Rawalpindi, Pakistan. Episodic memory was assessed using the Rey Auditory Verbal Learning Test (RAVLT) and Picnir Scales, semantic memory via the Semantic Memory Scale, and perceived stress through the Perceived Stress Scale (PSS). Correlational and mediation analyses were conducted.

Results: The results of this study demonstrated that perceived stress significantly mediated the relationship between episodic and semantic memory in both normotensive and hypertensive groups. Moreover, people with normal blood pressure had better memory when they felt less stress. However, in people with high blood pressure, stress had a stronger effect on memory, showing that they may be more mentally vulnerable. Additionally, moderation analysis revealed a more robust direct effect of episodic memory on semantic memory in normotensive participants compared to their hypertensive counterparts.

Conclusions: These findings highlight perceived stress as a critical neuropsychological mediator influencing memory systems, particularly under hypertensive conditions. Integrating stress-reduction strategies into cognitive interventions may help mitigate neurocognitive decline in hypertensive populations.