The Effect of Spiritual Orientation and Perceived Stress on Heart Rate Variability and Electrocardiographic...

Background: Hypertension is increasingly recognized as a complex psychophysiological condition in which psychological factors interact with autonomic regulation and cardiac electrical stability. This study aimed to investigate the associations of spiritual orientation, perceived stress, and self-efficacy with heart rate variability (HRV) and electrocardiographic (ECG) repolarization parameters in individuals with hypertension. Methods: A total of 200 participants were included, comprising 100 hypertensive patients and 100 age- and sex-matched healthy controls. HRV was assessed using time-domain indices (SDNN and RMSSD), while ECG parameters included heart rate, QRS duration, QT interval, Tp-e interval, and Tp-e/QT ratio. Psychosocial variables were evaluated using validated scales. Group comparisons, correlation analyses, and multivariate regression models were performed. Results: Compared with controls, hypertensive patients exhibited significantly lower SDNN (68.73 ± 10.74 vs. 82.85 ± 10.74 ms, p < 0.001, Cohen's d = 1.52) and RMSSD (35.55 ± 8.36 vs. 44.17 ± 8.36 ms, p < 0.001, d = 1.18), along with higher heart rate (74.73 ± 9.12 vs. 68.72 ± 8.85 bpm, p < 0.001, d = 1.11) and increased repolarization parameters, including QT interval (407 ± 18.3 vs. 397.58 ± 17.9 ms, p < 0.001, d = -0.69), Tp-e interval (97.95 ± 10.2 vs. 90.94 ± 9.8 ms, p < 0.001, d = 0.89), and Tp-e/QT ratio (0.24 ± 0.02 vs. 0.23 ± 0.02, p < 0.001). Spiritual orientation was positively correlated with SDNN (r = 0.274, p < 0.001) and RMSSD (r = 0.242, p < 0.001) and negatively correlated with heart rate (r = -0.277, p < 0.001), Tp-e (r = -0.256, p < 0.001), and Tp-e/QT ratio (r = -0.258, p < 0.001). Perceived stress showed inverse correlations with HRV indices and positive associations with repolarization parameters. In multivariate analysis, spiritual orientation remained an independent predictor of higher HRV indices, whereas perceived stress independently predicted a longer Tp-e interval and lower HRV. Conclusions: Spiritual orientation and stress-related factors are significantly associated with both autonomic function and cardiac repolarization in hypertension. These findings support a psychophysiological model in which psychosocial resources and stress responses jointly influence cardiovascular regulation. Integrating psychosocial assessment into hypertension management may provide additional insights beyond traditional risk factors.