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Panic attacks are more common in people with high blood pressure

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.

Panic attacks have only been recognized as a discrete entity since 1980, and it has been suggested that they may be related to hypertension. Now a study has come up with an answer. The definition of a panic attack is “ a discrete period of intense fear or discomfort involving at least four of the following symptoms:

  1. Shortness of breath or smothering symptoms
  2. Dizziness, unsteadiness or faintness
  3. Palpitations or rapid heart beats
  4. Trembling or shaking
  5. Sweating
  6. Choking
  7. Nausea or stomach upset
  8. Depersonalization or feeling of unreality
  9. Numbness or tingling
  10. Hot flushes or chills
  11. Chest pin or discomfort
  12. Fear of dying
  13. Fear of going crazy or losing control

The study looked at two samples of patients with high blood pressure (all were taking blood pressure lowering medications or had a blood pressure of at least 160/90mmHg), one of which was selected from a primary care practice, and the other from a hospital clinic, and compared them with the same number (about 350 people) of patients with normal pressure from the same family practice. All were sent questionnaires asking them if they had the symptoms described above.

The main finding was that panic attacks were significantly commoner in people with hypertension as opposed to those with a normal blood pressure: the percentages of people with panic attacks were 35% in the primary care practice, 39% in the hospital practice, and 22% in the normotensives. Both groups of hypertensives were more likely to have spontaneous panic attacks (ones that started for no obvious reason), and the attacks were more likely to be severe. The hypertensives were also more likely to report that they were generally anxious than the normotensives. The use of different types of antihypertensive drugs did not appear to influence whether or not the hypertensives had panic attacks. In most patients the panic attacks started after the hypertension. Whether hypertensive or not, women were more likely to report panic attacks than men.

Doctor’s comments

This study shows clearly that there is a connection between panic attacks and hypertension, but it does not tell us which is the chicken and which is the egg. The fact that the hypertension started before the attacks in most patients makes it unlikely that the attacks were the direct cause of the hypertension, however. Other studies have shown that blood pressure goes up during an attack, but it comes down again when the attack is over. What causes these attacks remains a mystery; although they have some relation with a generally anxious personality, this relationship is not very strong.

Where it was published

SJC Davies and colleagues. Association of panic disorder and panic attacks with hypertension. American Journal of Medicine 1999; 107:310.