By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

Many people think that the 'tension' in 'hypertension' refers to nervous tension, whereas in fact it refers to the mechanical tension in the blood vessels. However, a recent study suggests that nervous tension may also be involved. The authors analyzed data obtained from NHANES (the National Health and Nutrition Examination Survey), a study of more than 14,000 Americans who have been followed since 1975. At the beginning of the study participants answered a questionnaire which evaluated symptoms of depression and anxiety, and they had their blood pressure measured ten years later. The analysis reported here looked at the data of 2,992 individuals aged 25 to 64, none of whom were considered to be hypertensive when they entered the study.

The results showed that both anxiety and depression increased the risk of developing hypertension over the next ten years. In whites over the age of 45 who scored high on either anxiety or depression, the risk was approximately doubled, but was not apparent below the age of 45, perhaps because fewer people reported the symptoms. In blacks the relationships were even stronger: the increased risk for both anxiety and depression was approximately threefold, and was apparent in both younger and older individuals.

Doctor's comments

This study provides some of the strongest evidence to date that anxiety and depression may be risk factors for developing hypertension. Its chief virtues are the large number of people included in it, and the fact that it was a prospective study. In other words, there is no doubt that the symptoms of anxiety and depression preceded the hypertension, as opposed to being a consequence of it. There is generally a considerable overlap between anxiety and depression, and it is impossible to say from these results which of the two is more important. The results also lend credence to the idea that the more frequent occurrence of hypertension in blacks than in whites may be related to psychosocial influences.

Where it was published

Jonas B.S. and colleagues. Are symptoms of anxiety and depression risk factors for hypertension? Archives of Family Medicine1997;6:43-49