Anxiety disorders latest worry in high blood pressure

Family doctors and psychiatrists should carefully monitor the heart health of patients with anxiety disorders, Dr. Simon Bacon told the Canadian Cardiovascular Congress 2008, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society. "People with anxiety disorders are four times more likely to develop high blood pressure (hypertension) over one year than those of us who are anxiety free," says Dr. Bacon, a Heart and Stroke Foundation researcher at the Montreal Heart Institute. "Hypertension is a leading risk factor for stroke and heart disease."

Anxiety disorders are among the most common of all forms of mental illness, according to Dr. Bacon. People affected frequently (often daily) experience intense feelings of fear and distress that are typically out of proportion to the actual threat or danger. They also tend to disrupt daily functioning, including personal relationships and the ability to work. They include general anxiety disorder, panic disorder, obsessive compulsive disorder, and social phobia.

"Anxiety can cause increases in your blood pressure and heart rate. If it is persistent, those effects could be damaging," says Heart and Stroke Foundation researcher and spokesperson Dr. Brian Baker. "While we still need more understanding about how anxiety is associated with sustained high blood pressure, it is important that blood pressure is regularly monitored in people with anxiety disorders and that therapy - including anxiety management - is considered."

Dr. Bacon says that anxiety can lead to unhealthy lifestyle choices, including poor diet, smoking, and physical inactivity, which can also increase a person's overall risk for heart disease and stroke.

"In the general population, at any point in time, anxiety disorders affect approximately 12 per cent of people," says Dr. Bacon. "And, anxiety disorders are generally twice more common among women than among men." Dr. Bacon's research followed 185 patients with normal blood pressures for one year. The mean age of the patients was 58 years; 39 per cent were women, and 61 per cent were men. Sixteen per cent of patients had an anxiety disorder and 14 per cent had a mood disorder. Mood disorders include major depression, minor depression, and dysthymia.

Each patient underwent a structured psychiatric interview and provided information about their health. At the end of one year Dr. Bacon again collected information about participants' health.

Four per cent of the subjects without an anxiety disorder developed high blood pressure. However, 14 per cent of those who had an anxiety disorder developed hypertension.

The increase in high blood pressure did not apply to patients with mood disorders. "Our study also showed that patients who developed mood disorders were not at a higher risk of developing hypertension," says Dr. Bacon. "It is possible to have both," says Dr. Bacon. "It is very common to be depressed and anxious. But our study separated them out and found - at least over one year - that anxiety is a major culprit in hypertension."

Depression has a pronounced but indirect effect on the development of hypertension. People who are depressed tend to exercise less and make unhealthy lifestyle choices, according to Dr. Bacon.

But anxiety may create a direct, physiological response - a shock to the nervous system:

• Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least six months and can get worse if they are not treated.
• Anxiety disorders commonly occur along with other mental or physical illnesses, including depression, alcohol, or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.
• Effective therapies for anxiety disorders are available. Most people with anxiety disorders lead productive, fulfilling lives. People who think they have an anxiety disorder should seek information and treatment right away.

"One of the main messages here is that it is important to look after one's mental health as much as one's physical health," says Dr. Bacon. "If you have chronic anxious feelings, this could lead to worse heart health. There is no need to suffer - there are very good treatments out there."

Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect Foundation or CCS policy or position. The Heart and Stroke Foundation of Canada and the Canadian Cardiovascular Society make no representation or warranty as to their accuracy or reliability.

The Heart and Stroke Foundation (heartandstroke.ca), a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy.

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