I have a few friends who accelerated in subjects and got state ranks. One got top 10 in chemistry and the other got top 20 for mathematics 2U.
They were really motivated guys, but I don't think that they were stressed during their exams. I remember asking them about it and they said that it really just comes down to going over past papers and familiarizing yourself with the different questions.
I reckon people who strive to do their best end up achieving state ranks, while people studying specifically for the 'state-rank status' end up shooting themselves in the foot through all the unnecessary pressure and stress they put on themselves.