Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies

Yu Pan, Wenpeng Cai, Qi Cheng, Wei Dong, Ting An, Jin Yan, Yu Pan, Wenpeng Cai, Qi Cheng, Wei Dong, Ting An, Jin Yan

Abstract

Background: Epidemiological studies have repeatedly investigated the association between anxiety and hypertension. However, the results have been inconsistent. This study aimed to summarize the current evidence from cross-sectional and prospective studies that evaluated this association.

Methods: Seven common databases were searched for articles published up to November 2014. Cross-sectional and prospective studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratios or hazard ratios, and 95% confidence intervals (CIs) were extracted or calculated by the authors. The pooled odds ratio was calculated separately for cross-sectional and prospective studies using random-effects models. The Q test and I2 statistic was used to assess heterogeneity. A funnel plot and modified Egger linear regression test were used to estimate publication bias.

Results: The search yielded 13 cross-sectional studies (n=151,389), and the final pooled odds ratio was 1.18 (95% CI 1.02-1.37; P Q<0.001; I (2)=84.9%). Eight prospective studies with a total sample size of 80,146 and 2,394 hypertension case subjects, and the pooled adjusted hazard ratio was 1.55 (95% CI 1.24-1.94; P Q<0.001; I (2)=84.6%). The meta-regression showed that location, diagnostic criteria for anxiety, age, sex, sample size, year of publication, quality, and years of follow-up (for prospective study) were not sources of heterogeneity.

Conclusion: Our results suggest that there is an association between anxiety and increased risk of hypertension. These results support early detection and management of anxiety in hypertensive patients.

Keywords: anxiety disorder; epidemiological association; human; hypertension; meta-analysis.

Figures

Figure 1
Figure 1
Flow diagram of studies selection in meta-analysis.
Figure 2
Figure 2
Random effects meta-analysis of cross-sectional studies of the association between anxiety and hypertension (13 studies included). Note: Weights are from random effects analysis. Abbreviations: OR, odds ratio; CI, confidence interval.
Figure 3
Figure 3
Random effects meta-analysis of prospective studies of the association between anxiety and risk of hypertension (eight studies included). Note: Weights are from random effects analysis. Abbreviations: HR, hazards ratio; CI, confidence interval.

References

    1. World Health Organization Global health risks: mortality and burden of disease attributable to selected major risks. [Accessed January, 19 2015]. Available from: .
    1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–223.
    1. Fava C, Danese E, Montagnana M, et al. Serine/threonine kinase 39 is a candidate gene for primary hypertension especially in women: results from two cohort studies in Swedes. J Hypertens. 2011;29(3):484–491.
    1. Kowalik M. Psychosomatic aspects of arterial hypertension in women. Ann Univ Mariae Curie Sklodowska Med. 2004;59(1):245–249.
    1. Markovitz JH, Jonas BS, Davidson K. Psychologic factors as precursors to hypertension. Curr Hypertens Rep. 2001;3(1):25–32.
    1. Yan LL, Liu K, Matthews KA, Daviglus ML, Ferguson TF, Kiefe CI. Psychosocial factors and risk of hypertension: the Coronary Artery Risk Development in Young Adults (CARDIA) study. JAMA. 2003;290(16):2138–2148.
    1. Byrd JB, Brook RD. Anxiety in the “age of hypertension”. Curr Hypertens Rep. 2014;16(10):486–486.
    1. Reeves WC, Strine TW, Pratt LA, et al. Mental illness surveillance among adults in the United States. MMWR Surveill Summ. 2011;60(Suppl 3):1–29.
    1. McEvoy PM, Grove R, Slade T. Epidemiology of anxiety disorders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2011;45(11):957–967.
    1. Mendlowicz MV, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157(5):669–682.
    1. Stein DJ, Aguilar-Gaxiola S, Alonso J, et al. Associations between mental disorders and subsequent onset of hypertension. Gen Hosp Psychiatry. 2014;36(2):142–149.
    1. Johannessen L, Strudsholm U, Foldager L, Munk-Jørgensen 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):13–17.
    1. Ginty AT, Carroll D, Roseboom TJ, Phillips AC, de Rooij SR. Depression and anxiety are associated with a diagnosis of hypertension 5 years later in a cohort of late middle-aged men and women. J Hum Hypertens. 2013;27(3):187–190.
    1. Bacon SL, Campbell TS, Arsenault A, Lavoie KL. The impact of mood and anxiety disorders on incident hypertension at one year. Int J Hypertens. 2014;2014:953094.
    1. Grimsrud A, Stein DJ, Seedat S, Williams D, Myer L. The association between hypertension and depression and anxiety disorders: results from a nationally-representative sample of South African adults. PLoS One. 2009;4(5):e5552.
    1. Hamer M, Batty GD, Stamatakis E, Kivimaki M. Hypertension awareness and psychological distress. Hypertension. 2010;56(3):547–550.
    1. Shinn EH, Poston WSC, Kimball KT, St Jeor ST, Foreyt JP. Blood pressure and symptoms of depression and anxiety: a prospective study. Am J Hypertens. 2001;14(7):660–664.
    1. Wiltink J, Beutel ME, Till Y, et al. Prevalence of distress, comorbid conditions and well being in the general population. J Affect Disord. 2011;130(3):429–437.
    1. Hildrum B, Romild U, Holmen J. Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway. BMC Public Health. 2011;11:601.
    1. Hildrum B, Mykletun A, Stordal E, Bjelland I, Dahl AA, Holmen J. Association of low blood pressure with anxiety and depression: the Nord-Trondelag Health Study. J Epidemiol Community Health. 2007;61(1):53–58.
    1. Wells GA, Shea B, O’Connell D. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. [Accessed January 19, 2015]. Available from: .
    1. Rostom A, Dubé C, Cranney A. Celiac Disease-Appendix D Quality Assessment Forms. Rockville, MD, USA: Agency for Healthcare Research and Quality; 2004.
    1. Pan A, Keum N, Okereke OI, et al. Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care. 2012;35(5):1171–1180.
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–1558.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560.
    1. Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol. 2008;37(5):1148–1157.
    1. Tobias A. Assessing the influence of a single study in the meta-analysis estimate. Stata Technical Bulletin. 1999;47:15–17.
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–634.
    1. Paterniti S, Alperovitch A, Ducimetiere P, Dealberto MJ, Lepine JP, Bisserbe JC. Anxiety but not depression is associated with elevated blood pressure in a community group of French elderly. Psychosom Med. 1999;61(1):77–83.
    1. Wei T, Zeng C, Chen L, Wang S, Li S, Chen Q. Anxiety or/and depression in patients with hypertension. Chinese Journal of Hypertension. 2003;6:68–70. Chinese.
    1. Cheung BM, Au T, Chan S, et al. The relationship between hypertension and anxiety or depression in Hong Kong Chinese. Exp Clin Cardiol. 2005;10(1):21–24.
    1. Schmitz N, Thefeld W, Kruse J. Mental disorders and hypertension: factors associated with awareness and treatment of hypertension in the general population of Germany. Psychosom Med. 2006;68(2):246–252.
    1. Han J, Yin XM, Xu F, Hong X, Liang YQ, Wang ZY. A case-control study on depression and anxiety in hypertensive patients. Zhonghua Liu Xing Bing Xue Za Zhi. 2008;29(2):125–127. Chinese.
    1. 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):16–19.
    1. Hildingh C, Baigi A. The association among hypertension and reduced psychological well-being, anxiety and sleep disturbances: a population study. Scand J Caring Sci. 2010;24(2):366–371.
    1. 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):307–320.
    1. Fiedorowicz JG, He J, Merikangas KR. The association between mood and anxiety disorders with vascular diseases and risk factors in a nationally representative sample. J Psychosom Res. 2011;70(2):145–154.
    1. Markovitz JH, Matthews KA, Kannel WB, Cobb JL, D’Agostino RB. Psychological predictors of hypertension in the Framingham Study. Is there tension in hypertension? JAMA. 1993;270(20):2439–2443.
    1. 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(1):43–49.
    1. Raikkonen K, Matthews KA, Kuller LH. Trajectory of psychological risk and incident hypertension in middle-aged women. Hypertension. 2001;38(4):798–802.
    1. Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol. 2010;56(1):38–46.
    1. Chalmers JA, Quintana DS, Abbott MJ, Kemp AH. Anxiety disorders are associated with reduced heart rate variability: a meta-analysis. Front Psychiatry. 2014;5:80.
    1. Stein DJ, Gureje O. Depression and anxiety in the developing world: is it time to medicalise the suffering? Lancet. 2004;364(9430):233–234.
    1. Scalco AZ, Scalco MZ, Azul JB, Lotufo Neto F. Hypertension and depression. Clinics (Sao Paulo) 2005;60(3):241–250.
    1. Long J, Duan G, Tian W, et al. Hypertension and risk of depression in the elderly: a meta-analysis of prospective cohort studies. J Hum Hypertens. 2014 Nov 20; Epub ahead of print.
    1. Licht CM, de Geus EJ, Seldenrijk A, et al. Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension. 2009;53(4):631–638.
    1. Spruill TM, Pickering TG, Schwartz JE, et al. The impact of perceived hypertension status on anxiety and the white coat effect. Ann Behav Med. 2007;34(1):1–9.
    1. Ogedegbe G, Pickering TG, Clemow L, et al. The misdiagnosis of hypertension: the role of patient anxiety. Arch Intern Med. 2008;168(22):2459–2465.
    1. Kayano H, Koba S, Matsui T, et al. Anxiety disorder is associated with nocturnal and early morning hypertension with or without morning surge – ambulatory blood pressure monitoring. Circ J. 2012;76(7):1670–1677.
    1. Saavedra JM, Ando H, Armando I, et al. Anti-stress and anti-anxiety effects of centrally acting angiotensin II AT1 receptor antagonists. Regul Pept. 2005;128(3):227–238.
    1. Braszko JJ, Kulakowska A, Winnicka MM. Effects of angiotensin II and its receptor antagonists on motor activity and anxiety in rats. J Physiol Pharmacol. 2003;54(2):271–281.
    1. Fujino T, Nakagawa N, Yuhki K, et al. Decreased susceptibility to renovascular hypertension in mice lacking the prostaglandin I 2 receptor IP. J Clin Invest. 2004;114(6):805–812.
    1. Lambert E, Dawood T, Straznicky N, et al. Association between the sympathetic firing pattern and anxiety level in patients with the metabolic syndrome and elevated blood pressure. J Hypertens. 2010;28(3):543–550.
    1. Bajko Z, Szekeres CC, Kovacs KR, et al. Anxiety, depression and autonomic nervous system dysfunction in hypertension. J Neurol Sci. 2012;317(1–2):112–116.
    1. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99(16):2192–2217.
    1. Narita K, Murata T, Hamada T, et al. Interactions among higher trait anxiety, sympathetic activity, and endothelial function in the elderly. J Psychiatr Res. 2007;41(5):418–427.
    1. DiBona GF. The sympathetic nervous system and hypertension: recent developments. Hypertension. 2004;43(2):147–150.
    1. Mancia G, Grassi G. The autonomic nervous system and hypertension. Circ Res. 2014;114(11):1804–1814.
    1. Harris KF, Matthews KA. Interactions between autonomic nervous system activity and endothelial function: a model for the development of cardiovascular disease. Psychosom Med. 2004;66(2):153–164.
    1. Kudielka BM, Wüst S. Human models in acute and chronic stress: assessing determinants of individual hypothalamus-pituitary-adrenal axis activity and reactivity. Stress. 2009;13(1):1–14.
    1. Hashimoto K, Makino S, Hirasawa R, et al. Abnormalities in the hypothalamo-pituitary-adrenal axis in spontaneously hypertensive rats during development of hypertension. Endocrinology. 1989;125(3):1161–1167.
    1. Bonnet F, Irving K, Terra JL, Nony P, Berthezene F, Moulin P. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis. 2005;178(2):339–344.
    1. Bautista LE, Vera-Cala LM, Colombo C, Smith P. Symptoms of depression and anxiety and adherence to antihypertensive medication. Am J Hypertens. 2012;25(4):505–511.
    1. Khatib R, Schwalm JD, Yusuf S, et al. Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PLoS One. 2014;9(1):e84238.
    1. Grossman E, Nadler M, Sharabi Y, Thaler M, Shachar A, Shamiss A. Antianxiety treatment in patients with excessive hypertension. Am J Hypertens. 2005;18(9 Pt 1):1174–1177.
    1. Ahmadpanah M, Paghale SJ, Bakhtyari A, et al. Effects of psychotherapy in combination with pharmacotherapy, when compared to pharmacotherapy only on blood pressure, depression, and anxiety in female patients with hypertension. J Health Psychol. 2014 Oct 7; Epub ahead of print.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren