Depression and High Blood Pressure

Can depression and anxiety help cause hypertension?

You don't need to measure your blood pressure to know that a heated argument or a walk down a dark alley can send that pressure soaring. Your pounding heart and flushed face say it all. Stress can temporarily boost blood pressure: For instance, some people have short-term hikes in blood pressure when they visit a doctor's office. Fortunately, these spikes in pressure are usually too fleeting to threaten your health. But when emotional turmoil becomes a way of life, your blood pressure can take a dangerous, long-term climb. Researchers at the Centers for Disease Control and Prevention (CDC) provide evidence that depression and severe anxiety may increase a person's risks for developing hypertension.

The landmark CDC study got its start in the early 1970s with thorough psychological testing of nearly 3,000 adults with normal blood pressure. When researchers checked the blood pressure and medical records of the subjects between seven and 16 years later, they spotted a remarkable trend: People suffering from either severe depression or anxiety at the start of the study were two to three times more likely than the others to develop hypertension. The researchers had made adjustments for smoking, age, history of heart disease, and other factors to arrive at the results. For the first time, researchers could see that depression and hypertension -- two of the most pervasive and costly conditions in America -- were intimately related.

Since then, other investigations have found connections between hypertension and psychological distress. British researchers reported that patients with hypertension were particularly likely to have a history of panic attacks, or sudden feelings of terror that strike repeatedly and unexpectedly. And a study by New York Presbyterian Hospital (NYPH) showed that psychological trauma, whether recent or in the past, can lead to chronic episodes of surging blood pressure accompanied by symptoms such as chest pain, nausea, and shortness of breath.

How can mood affect blood pressure?

Depression and anxiety often lead people to smoke, drink excessively, and gain weight, behaviors that can definitely promote hypertension and heart disease. But the CDC study suggests that the connection between mood and hypertension may be more direct than that. Experts suspect that anxiety and depression put the body on constant alert, which places a strain on many organ systems.

Can treatment for depression help prevent hypertension?

In some cases, it seems to help. The researchers at NYPH found that hypertension medications, when combined with psychotherapy and antidepressants, helped prevent severe attacks of high blood pressure in over 60 percent of their patients. But there isn't much evidence that depression treatment can help prevent the subtler form of ongoing hypertension that puts millions of Americans at risk for heart disease. In fact, the chemical reactions caused by modern antidepressants can actually raise blood pressure slightly. Your physician can evaluate which medications are best suited to your condition.

Still, there's no doubt that treatment for depression can be a huge gift to the heart. There are indications that depressed people who are otherwise healthy are more likely than their non-depressed peers to develop heart disease. For example, a 13-year study of 1,500 subjects conducted at Johns Hopkins University found that an episode of depression increased the risk of a heart attack more than fourfold. And researchers at Duke University Medical Center recently reported that a stress-management program cut the chances that a heart patient would suffer a heart attack or need surgery by 74 percent.

The good news is that both hypertension and depression are very treatable. Whether you need medication for hypertension or depression, a class in techniques for stress reduction, or adjustments in your diet and lifestyle, there are many treatments now available. The current research is encouraging: With proper intervention, both hypertension and depression can be controlled -- and both you and your body will feel the benefit.

Further Resources

Markovitz JH et al. Psychologic factors as precursors to hypertension. Current Hypertension Reports. Vol. 3(1): 25-32.

Everson SA et al. Hypertension incidence is predicted by high levels of hopelessness in Finnish men. Hypertension. Vol. 35(2): 561-567.

References

People with high blood pressure more prone to panic disorder. Harv Heart Lett, Vol. 10(7):7

Mann, Samuel J. Severe Paroxysmal Hypertension: Understanding the Cause and Treatment. Archives of Internal Medicine, Vol 159

Jonas, Bruce J et al. Are Symptoms of Anxiety and Depression Risk Factors for Hypertension? Archives of Family Medicine, Vol 6

Pratt LA et al. Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up. Circulation. Vol. 94(12): 3123-3129.

Markovitz JH et al. Psychologic factors as precursors to hypertension. Current Hypertension Reports. Vol. 3(1): 25-32.

Everson SA et al. Hypertension incidence is predicted by high levels of hopelessness in Finnish men. Hypertension. Vol. 35(2): 561-567.

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