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Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension

  • Secondary Hypertension: Nervous System Mechanisms (M Wyss, Section Editor)
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Abstract

Purpose of Review

To review the most recent literature on the association between comorbid anxiety disorders and hypertension.

Recent Findings

Recent longitudinal and cross-sectional studies across geographic regions and age groups predominantly demonstrate a positive association between comorbid anxiety and prevalent or incident hypertension. Growing research on blood pressure variability and reduced baroreflex sensitivity in response to autonomic dysfunction provides a greater understanding of mechanistic relationships between anxiety and hypertension. Observational studies demonstrate that young adults are at a higher risk for developing incident hypertension after an anxiety diagnosis, supporting longer exposure to alterations in autonomic mechanisms. Confounding relationships of comorbid anxiety with depression likely contribute to prior conflicting results on the association between anxiety and hypertension.

Summary

There is increasing evidence of a positive association between comorbid anxiety and hypertension. This contemporaneous review supports similar findings in historical studies and provides mechanistic hypotheses for larger, longitudinal studies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control. Circulation. 2016;134:441–50. https://doi.org/10.1161/CIRCULATIONAHA.115.018912.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2010;380:2224–60. https://doi.org/10.1016/S0140-6736(12)61766-8.

    Article  Google Scholar 

  3. World Health Organization. Global Health Observatory (GHO) data. Raised blood pressure – situation and trends. Website: https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/Accessed May 31, 2019.

  4. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al., on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics 2019 update: a report from the American Heart Association [published online ahead of print January 31, 2019]. Circulation. https://doi.org/10.1161/CIR.0000000000000659.

  5. Bacon SL, Campbell TS, André A, Lavoie KL. The impact of mood and anxiety disorders on incident hypertension at one year. Int J Hypertens. 2014;2014(953094):7. https://doi.org/10.1155/2014/953094.

    Article  Google Scholar 

  6. Website: https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml. Accessed May 31, 2019.

  7. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015;17:3.

    Google Scholar 

  8. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization 2017. License: CC BY-NC-SA 3.0 IGO. Website: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf;jsessionid=3C066D350D7C8E8630F9F3DF6844E976?sequence=1. Accessed June 28, 2019.

  9. O’Donovan A, Slavich GM, Epel ES, Neylan TC. Exaggerated neurobiological sensitivity to threat as a mechanism linking anxiety with increased risk for diseases of aging. Neurosci Biobehav Rev. 2013;37:96–108.

    Article  Google Scholar 

  10. Sherbourne CD, Wells KB, Meredith LS, Jackson CA, Camp P. Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Arch Gen Psychiatry. 1996;53(10):889–95.

    Article  CAS  Google Scholar 

  11. •• Wallace K, Zhao X, Misra R, Sambamoorthi U. The humanistic and economic burden associated with anxiety and depression among adults with comorbid diabetes and hypertension. J Diabetes Res. 2018;2018(4842520):9. https://doi.org/10.1155/2018/4842520 eCollection 2018. This analysis of data from the 2013 and 2015 United States Medical Expenditure Panel Survey evaluated the health-related quality of life (HRQoL) and economic burden on the presence of anxiety among patients with hypertension and other comorbidities. This study highlights the need for cost-effective, collaborative care for patients with comorbid conditions.

    Article  Google Scholar 

  12. Rutledge T, Hogan BE. A quantitative review of prospective evidence linking psychological factors with hypertension development. Psychosom Med. 2002;64(5):758–66.

    PubMed  Google Scholar 

  13. Hildrum B, Mykletun A, Holmen J, Dahl A. Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. Br J Psychiatry. 2008;193(2):108–13. https://doi.org/10.1192/bjp.bp.107.045013.

    Article  PubMed  Google Scholar 

  14. Wu EL, Chien IC, Lin CH. Increased risk of hypertension in patients with anxiety disorders: a population-based study. J Psychosom Res. 2014;77:522–7.

    Article  Google Scholar 

  15. Cuffee Y, Ogedegbe C, Williams NJ, Ogedegbe G, Schoenthaler A. Psychosocial risk factors for hypertension: an update of the literature. Curr Hypertens Rep. 2014;16(10):483. https://doi.org/10.1007/s11906-014-0483-3.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kaliyaperumal S, Hari SB, Siddela PK, Yadala S. Assessment of quality of life in hypertensive patients. J Appl Pharm Sci. 2016;6(05):143–7.

    Article  Google Scholar 

  17. Saboya PM, Zimmermann PR, Bodanese LC. Association between anxiety or depressive symptoms and arterial hypertension, and their impact on the quality of life. Int J Psychiatry Med. 2010;40(3):307–20.

    Article  Google Scholar 

  18. Jonas BS, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med. 1997;6:43–9.

    Article  CAS  Google Scholar 

  19. Player MS, Peterson LE. Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med. 2011;41(4):365–77.

    Article  Google Scholar 

  20. Bhat SK, Beilin LJ, Robinson M, Burrows S, Mori TA. Relationships between depression and anxiety symptoms scores and blood pressure in young adults. J Hypertens. 2017;35:1983–91.

    Article  CAS  Google Scholar 

  21. Markovitz JH, Matthews KA, Wing RR, Kuller LH, Meilahn EN. Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women. J Hypertens. 1991;9:399–406.

    Article  CAS  Google Scholar 

  22. Perez-Pinar M, Mathur R, Foguet Q, Ayis S, Robson J, Ayerbe L. Cardiovascular risk factors among patients with schizophrenia, bipolar, depression, anxiety, and personality disorders. European Psychiatry. 2016;35:8–15.

    Article  CAS  Google Scholar 

  23. Jonas BS, Lando JF. Negative affect as a prospective risk factor for hypertension. Psychosom Med. 2000;62:188–96.

    Article  CAS  Google Scholar 

  24. László A, Tabák A, Kőrösi B, Eörsi D, Torzsa P, Cseprekál O, et al. Association of affective temperaments with blood pressure and arterial stiffness in hypertensive patients: a cross-sectional study. BMC Cardiovasc Disord. 2016;16:158. https://doi.org/10.1186/s12872-016-0337-9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cheung BM, Au T, Chan S, Lam C, Lau S, Lee R, et al. The relationship between hypertension and anxiety or depression in Hong Kong Chinese. Exp Clin Cardiol. 2005;10:21–4.

    PubMed  PubMed Central  Google Scholar 

  26. Johannessen L, Strudsholm U, Foldager L, Munk-Jørgenson P. Increased risk of hypertension in patients with bipolar disorder and patients with anxiety compared to background population and patients with schizophrenia. J Affect Disord. 2006;95(1–3):13–7.

    Article  Google Scholar 

  27. Egan BM, Zhao Y. Different definitions of prevalent hypertension impact: the clinical epidemiology of hypertension and attainment of Healthy People goals. J Clin Hypertens (Greenwich). 2013;15(3):154–61. https://doi.org/10.1111/jch.12057.

    Article  Google Scholar 

  28. Johnson HM, Thorpe CT, Bartels CM, Schumacher JR, Palta M, Pandhi N, et al. Undiagnosed hypertension among young adults with regular primary care use. J Hypertens. 2014;32(1):65–74. https://doi.org/10.1097/HJH.0000000000000008.

    Article  CAS  PubMed  Google Scholar 

  29. Delaney JA, Oddson BE, Kramer H, Shea S, Psaty BM, McClelland RL. Baseline depressive symptoms are not associated with clinically important levels of incident hypertension during two years of follow-up: the multi-ethnic study of atherosclerosis. Hypertension. 2010;55(2):408–14. https://doi.org/10.1161/hypertensionaha.109.139824.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Stein DJ, Aguilar-Gaxiola S, Alonso J, Bruffaerts R, de Jonge P, Miguel Caldas-de-Almeida J, et al. Associations between mental disorders and subsequent onset of hypertension. Gen Hosp Psychiatry. 2014;36(2):142–9. https://doi.org/10.1016/j.genhosppsych.2013.11.002.

    Article  PubMed  Google Scholar 

  31. Jarman B, Townsend P, Carstairs V. Deprivation indices. BMJ. 1991;303(6801):523.

    Article  CAS  Google Scholar 

  32. Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28(5):403–39.

    Article  Google Scholar 

  33. Jackson JA, Pathirana T, Gardiner PA. Depression, anxiety and risk of hypertension in mid-aged women: a prospective longitudinal study. J Hypertens. 2016;34:1959–66.

    Article  CAS  Google Scholar 

  34. Low M, Stegmaier C, Ziegler H, Rothenbacher D, Brenner H. Epidemiological investigations of the chances of preventing, recognizing early and optimally treating chronic diseases in an elderly population (ESTHER study). Dtsch Med Wochenschr. 2004;129:2643–7.

    Article  CAS  Google Scholar 

  35. Matouk I, Herzog W, Bohlen F, Quinzler R, Lowe B, Saum KU, et al. Association of hypertension with depression and generalized anxiety symptoms in a large population-based sample of older adults. J Hypertens. 2016 Sep;34(9):1711–20. https://doi.org/10.1097/HJH.0000000000001006.

    Article  CAS  Google Scholar 

  36. Meng L, Chen D, Yang Y, Zheng Y, Hui R. Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. J Hypertens. 2012;30(5):842–51. https://doi.org/10.1097/HJH.0b013e32835080b7.

    Article  CAS  PubMed  Google Scholar 

  37. Carroll D, Phillips AC, Gale CR, Batty GD. Generalized anxiety and major depressive disorders, their comorbidity and hypertension in middle-aged men. Psychosom Med. 2010;72(1):16–9.

    Article  Google Scholar 

  38. Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC, et al. Depression–anxiety relationships with chronic physical conditions: results from the World Mental Health surveys. J Affect Disord. 2007;103(1–3):113–20.

    Article  CAS  Google Scholar 

  39. • Sandstrom YK, Ljunggren G, Wandell P, Wahlstrom L, Carlsson AC. Psychiatric comorbidities in patients with hypertension – a study of registered diagnoses 2009–2013 in the total population in Stockholm County, Sweden. J Hypertens. 2016;34:414–20 Analysis of this observational cohort of over 2 million adults in Sweden demonstrated significantly higher rates of hypertension among men and women with anxiety, after adjusting for age, sociodemographic factors, and health behavior.

    Article  Google Scholar 

  40. Niles AN, Dour HJ, Stanton AL, Roy-Byrne PP, Stein MB, Sullivan G, et al. Anxiety and depressive symptoms and medical illness among adults with anxiety disorders. J Psychosom Res. 2015;78(2):109–15. https://doi.org/10.1016/j.jpsychores.2014.11.018.

    Article  PubMed  Google Scholar 

  41. Seldenrijk A, Vogelzangs N, Batelaan NM, Wieman I, et al. Depression, anxiety and 6-year risk of cardiovascular disease. J Psychosom Res. 2015;78(2):123–9.

    Article  Google Scholar 

  42. Januzzi JL, Stern TA, Pasternak RC, DeSanctis RW. The influence of anxiety and depression on outcomes of patients with coronary artery disease. Arch Intern Med. 2000;160(13):1913–21. https://doi.org/10.1001/archinte.160.13.1913.

    Article  PubMed  Google Scholar 

  43. •• Tully PJ, Tzourio C. Psychiatric correlates of blood pressure variability in the elderly: The Three City cohort study. Physiol Behav. 2017;168:91–87. https://doi.org/10.1016/j.physbeh.2016.10.024 This prospective analysis of over 1400 elderly participants demonstrated that generalized anxiety disorder is significantly associated with increased systolic blood pressure variability over 8 years of follow-up, contributing mechanistic pathophysiology data between comorbid anxiety and hypertension.

    Article  CAS  PubMed  Google Scholar 

  44. Irigoyen MC, De Angelis K, dos Santos F, Dartora DR, Rodrigues B, Consolim-Colomdo FM. Hypertension, blood pressure variability, and target organ lesion. Curr Hypertens Rep. 2016;18:31. https://doi.org/10.1007/s11906-016-0642-9.

    Article  PubMed  Google Scholar 

  45. Piccirillo G, Elvira S, Bucca C, Viola E, Cacciafesta M, Marigliano V. Abnormal passive head-up tilt test in subjects with symptoms of anxiety power spectral analysis study of heart rate and blood pressure. Int J Cardiol. 1997;60(2):121–31.

    Article  CAS  Google Scholar 

  46. Virtanen R, Jula A, Salminen J, Voipio-Pulkki LM, Helenius H, Kuusela T, et al. Anxiety and hostility are associated with reduced baroreflex sensitivity and increased beat-to-beat blood pressure variability. Psychosom Med. 2003;65(5):751–6.

    Article  Google Scholar 

  47. Strine TW, Mokdad AH, Dube SR, Balluz LS, Gonzalez O, Berry JT, et al. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry. 2008;30(2):127–37. https://doi.org/10.1016/j.genhosppsych.2007.12.008.

    Article  PubMed  Google Scholar 

  48. Grimm ER, Steinle NI. Genetics of eating behavior: established and emerging concepts. Nutr Rev. 2011;69:52–60. https://doi.org/10.1111/j.1753-4887.2010.00361.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Mensorio MS, Cebolla A, Lison JF, Rodilla E, Palomar G, Miragall M, et al. Emotional eating as a mediator between anxiety and cholesterol in population with overweight and hypertension. Psychol Health Med. 2017;22(8):911–8. https://doi.org/10.1080/13548506.2016.1271134.

    Article  PubMed  Google Scholar 

  50. van Strien T, Frijters JER, Bergers GPA, Defares PB. The Dutch eating behavior questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord. 1986;5:295–315.

    Article  Google Scholar 

  51. van Strien T, Cebolla A, Etchemendy E, Gutierrez-Maldonado J, Ferrer-Garcia M, Botella C, et al. Emotional eating and food intake after sadness and joy. Appetite. 2013;66:20–5. https://doi.org/10.1016/j.appet.2013.02.016.

    Article  PubMed  Google Scholar 

  52. van Strien T, Konttinen H, Homberg JR, Engels RCME, Winkens LHH. Emotional eating as a mediator between depression and weight gain. Appetite. 2016;100:216–24. https://doi.org/10.1016/j.appet.2016.02.034.

    Article  PubMed  Google Scholar 

  53. Goossens L, Braet C, Van Vlierberghe L, Mels S. Loss of control over eating in overweight youngsters: the role of anxiety, depression and emotional eating. Eur Eat Disord Rev. 2009;17:68–78.

    Article  Google Scholar 

  54. Assari S. Additive effects of anxiety and depression on body mass index among blacks: role of ethnicity and gender. Int Cardiovasc Res J. 2014;8(2):44–51.

    PubMed  PubMed Central  Google Scholar 

  55. Lykouras L. Psychological profile of obese patients. Dig Dis. 2008;26:36–9. https://doi.org/10.1159/000109384.

    Article  PubMed  Google Scholar 

  56. Ho AK, Thorpe CT, Pandhi N, Palta M, Smith MA, Johnson HM. Association of anxiety and depression with hypertension control: a US multidisciplinary group practice observational study. J Hypertens. 2015;33(11):2215–22. https://doi.org/10.1097/HJH.0000000000000693.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Kretchy IA, Owusu-Daaku FT, Danquah SA. Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. Int J Ment Heal Syst. 2014;8:25. https://doi.org/10.1186/1752-4458-8-25.

    Article  Google Scholar 

  58. Sullivan G, Craske MG, Sherbourne C, Edlund MJ, Rose RD, et al. Design of the coordinated anxiety learning and management (CALM) study: innovations in collaborative care for anxiety disorders. Gen Hosp Psychiatry. 2007;29(5):379–87.

    Article  Google Scholar 

  59. Istenes I, Körei AE, Putz Z, Németh N, Martos T, Keresztes K, et al. Heart rate variability is severely impaired among type 2 diabetic patients with hypertension. Diabetes Metab Res Rev. 2014;30(4):305–12.

    Article  Google Scholar 

  60. Mermerelis A, Kyvelou SM, Akke V, Papageorgiou C, Stefanadis C, Douzenis A. EV0029. Is there a difference in prevalence of anxiety and depression symptoms among patients with different stages of hypertension? Abstract. 25th European Congress of Psychiatry/European Psychiatry 41S 2017:S405–S464.

  61. Pan Y, Cai W, Cheng Q, Dong W, An T, Yan J. Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies. Neuropsychiatr Dis Treat. 2015;11:1121–30. https://doi.org/10.2147/NDT.S77710.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Cohen BE, Edmondson D, Kronish IM. State of the art review: depression, stress, anxiety, and cardiovascular disease. Am J Hypertens. 2015;28(11):1295–302. https://doi.org/10.1093/ajh/hpv047.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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  1. Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine & Public Health, H4/512 CSC, MC 3248, 600 Highland Avenue, Madison, WI, 53792, USA

    Heather M. Johnson

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Johnson, H.M. Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension. Curr Hypertens Rep 21, 66 (2019). https://doi.org/10.1007/s11906-019-0972-5

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