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Brain & Heart Depression, anxiety and blood pressure control

affect each other. An important aspect of this interaction, lifestyle. Women of reproductive age seem to have a lower
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not only in research but also in everyday clinical practice, risk of depression than men and postmenopausal women,
is arterial hypertension because it correlates with both highlighting the role of sex hormones in the development
cardiovascular functioning and nervous system reactions. of depression. 10
Arterial hypertension, anxiety, and depression are all 2.2. Epidemiologic inter-relationship between
common in both Western and Eastern medicines, and depression and hypertension
both approaches provide us with therapeutic instructions
and proposals. Eastern medicine focuses on effectively 2.2.1. Frequency of depression among patients with
reducing hypertension and mood disorders, to a certain hypertension
point, using techniques that target brain function, skipping Monitoring depressive symptoms in patients with
cardiovascular system per se. In Western medicine, in hypertension is essential in psychocardiology. This can
“our little world,” non-pharmaceutical remedies have not be achieved using widely approved scales, particularly
been yet approved as medical therapy. What is the most in research. However, their value is questioned when
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important is the knowledge that reaches us through these seeking a clinical diagnosis because these scales focus on
techniques: “approaching the brain, with no drugs at all, somatic symptoms, and a clinician’s approach is missing.
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can alter the blood pressure (BP) inside our vessels.” This Consequently, the incidence of depression in patients with
states strong evidence in favor of the connection between hypertension might be under- or overestimated.
our mind and heart. In 2015, Li et al. conducted a systematic meta-analysis
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2. Psychocardiology: Connecting of 41 articles to estimate the incidence of depression
hypertension, anxiety, and depression in patients with hypertension, using either with self-
questionnaires or clinical examinations. They concluded
2.1. Epidemiology of arterial hypertension and that the incidence of depression was higher (approximately
depression 30%) in participants who completed the questionnaires
by themselves but lower (approximately 21%) when a
2.1.1. Epidemiology of arterial hypertension
psychiatrist assessed their emotional status. This difference
Arterial hypertension has been implicated in more than can be attributed to the known limitations of self-reported
7.8 million deaths annually worldwide and has been questionnaires.
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identified as a fatal factor causing cardiovascular diseases
and raising global mortality. In the last 50 years, the use 2.2.2. Frequency of hypertension among patients with
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of antidepressants has allowed us to keep the main arterial depression and anxiety
pressure relatively stable, a goal that could not be achieved Similarly, in 2014, Stein et al. almost concurrently with the
in countries plagued with poverty. By 2025, 1.5 million study by Lee et al. in South Africa investigated the possible
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more people are expected to add to the number of patients relationship between the first episode of depression or
with arterial hypertension worldwide. 5 anxiety and the first episode of hypertension. They
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Poorly controlled arterial hypertension can cause or gathered data from the World Mental Health Surveys
exacerbate various medical conditions, such as coronary involving 19 countries and 52,095 participants and
disease, stroke, cardiac failure, and adrenal failure. These conducted survival analysis. They attempted to estimate
conditions adversely affect the global economy, particularly the relationship between the first onset of hypertension
in low- and middle-income countries, where the annual and common mental illnesses considering variables such
cost of cardiovascular diseases is estimated to reach up to as the sex and age of the participants. According to their
500 billion dollars, equivalent to 2% of the gross national results, depression, panic disorder, social phobia, and
product between 2011 and 2025. 6 specific phobias were related to hypertension, with odds
ratios (OR) of 1.4 for depression and 1.7 for anxiety.
2.1.2. Epidemiology of major depression At around the same time, Sandstrom et al. conducted
According to the World Health Organization, depression a large survey in Sweden in January 2011, investigating
affects over 322 million people worldwide, with an overall the same parameters. Their sample consisted of
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incidence of 4.4%. Older people and women are more 2,058,408 residents in Stockholm. They gathered data
susceptible: 7.5% of women compared with 5.5% of men from patients with ICD 10 diagnosis (I10, hypertension)
aged 55 – 75 years. Although women are more likely to from 2009 to 2013, either as outpatients or inpatients. In
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suffer from depression, men with depression are more likely addition, they included data from individuals with the
to develop hypertension, probably due to an unhealthy following psychiatric diagnoses during the same 4-year

Volume 3 Issue 1 (2025) 2 doi: 10.36922/bh.4923