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Brain & Heart Depression, anxiety and blood pressure control

period: F20, schizophrenia; F30 – 31, bipolar disorder; Similarly, Meng et al. conducted a meta-analysis of nine
F32 – 33, depression; and F40 – 41, anxiety disorders. studies involving 22,367 patients with depression who have
They investigated the relationship between hypertension been followed for nearly 10 years. They found that patients
and psychopathology and concluded that patients with with depression had a 1.42 higher risk of developing
hypertension were more likely to suffer from anxiety and hypertension than those without depression. Therefore,
depression, particularly younger or female patients. researchers proposed depression as an independent risk
In Taiwan, Wu et al. conducted a large survey involving factor for hypertension. 21
23.5 million people. The researchers gained access to the 2.3.2. Hypertension causes anxiety and depression
16
National Health Research Institute of Taiwan and took a
random sample of 766,427 patients (both outpatients and Hypertension has been implicated in anxiety and
inpatients) aged >18 years, who had been diagnosed with depressive symptoms. This could be attributed to the direct
a depressive disorder or hypertension. Thereafter, they effects of high BP, side effects of antihypertensive drugs, or
compared the incidence of hypertension between patients psychological reactions to the diagnosis of hypertension.
with depression and the general population. They concluded In 2010, Hamer et al. analyzed a large sample of
that the incidence of hypertension was higher in patients 33,105 adults (mean age, 51.7 years). They unveiled that
with depression (21%) than in the general population (13%). individuals with hypertension who were aware of their

The United States of America has actively participated in high BP exhibited more anxiety and depression symptoms
the investigation of the relationship between hypertension, (OR 1.57) than those who ignored their high BP level (OR
depression, and anxiety. From 2017 to 2018, Shah et al. 0.91). They concluded that the diagnosis of hypertension
analyzed the National Health and Nutrition Examination can cause psychological diseases in these patients. 22
Survey data. All participants were asked to complete
17
self-reported questionnaires concerning their mental 2.3.3. Pathophysiologic mechanisms of hypertension–
and somatic health states. The researchers investigated anxiety–depression connection
the coexistence of depressive and anxiety symptoms with Depression was found to cause hypertension. This also
23
hypertension in 74,285,160 adults living in poverty. They holds true for anxiety given that it affects the autonomous
concluded that patients taking antidepressive (OR 2.72) or nervous system. Multiple mechanisms ran through
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antianxiety medications (OR 2.50) were more likely to suffer this connection (Figure 1). First, extensive genetic
from hypertension. In addition, individuals who reported correlations and genetic overlaps were identified between
depressive symptoms daily (OR 2.28) or quite frequently neuropsychiatric disorders and cardiovascular disease,
(OR 1.88) were more likely to have hypertension. 17 providing important insights into the brain–heart axis and
A similar study focusing on individuals living in therapeutic targets in clinical practice. 25
poverty was conducted in Ethiopia in 2019. Afework Second, people with anxiety and depression live an
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et al. enrolled 404 individuals who were randomly selected unhealthy lifestyle. They are unlikely to work out and
from patients visiting the Dessie Referral Hospital between are more disposed toward tobacco and alcohol abuse.
February and April 2019. Finally, 384 patients agreed to Moreover, patients with anxiety and depression often take
participate in the study. Their mental health condition, medications that can result in weight gain as well as side
assessed by a clinical psychiatrist, was correlated with effects such as metabolic syndrome and hypertension.
several variables concerning their somatic health; 34.8% Stress negatively affects endothelium function via the
of individuals with hypertension also presented with an sympathetic nervous system, leading to hypertension.
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anxiety disorder, whereas 5.2% presented with depression.
In addition, anxiety and depression hyperactivate the
2.3. Pathophysiology of hypertension–anxiety– hypothalamus–pituitary axis, inducing the release of
depression connection glucocorticoids, which increases the sensitivity of vascular
smooth muscle cells to catecholamines. This mechanism
2.3.1. Anxiety and depression can induce further elevates BP. 27-30
hypertension
Moreover, depression is associated with a state of chronic
Anxiety and depression are risk factors for arterial inflammation. Inflammatory agents, such as C-reactive
hypertension, increasing the risk for sudden death 3 protein, also contribute to the development of hypertension. 31
– 5 times. Jackson et al. examined 9182 middle-aged
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women with depression, of which 30% were at risk of Finally, anxiety and depression are linked to the
hypertension (OR 1.30) and 24% with anxiety disorder renin-angiotensin-aldosterone system, which also
were more vulnerable to hypertension. 20 plays an important role in controlling BP. In addition,

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