Anxiety and hypertension: How chronic, long-term anxiety may be contributing to your high blood pressure

Anxiety is one of the most common mental health issues in North America, affecting around 20 per cent of adults. It has significant impacts on health and quality of life, and is linked to multiple other health conditions. Anxiety often presents as “overthinking” or “over-worrying” and can impede relationships, work and simple day-to-day activities. It has a reciprocal relationship with health conditions, meaning physical symptoms may cause or worsen anxiety, and anxiety may worsen physical symptoms. Treating underlying mental health conditions is an essential part of the healing process.

Hypertension, or high blood pressure, affects a similar number of people as anxiety (around 25 per cent of adults) and is the leading cause of preventable death and disability in Canada. Hypertension is multifactorial in its cause, and can arise from genetics (or a family history of cardiovascular disease), lifestyle choices and even psychosocial factors like stress and anxiety. When changes are made to modifiable risk factors like lack of exercise, high salt intake and chronic stress, this decreases your risk of serious cardiovascular events like heart attack and stroke.

Researchers have been interested in the correlation between hypertension and anxiety for decades, and the rising prevalence of both makes this relationship all the more compelling. Is anxiety associated with hypertension? Let’s find out.

White Coat Syndrome

There’s a common phenomenon termed “white coat syndrome,” where acute or situational anxiety increases your blood pressure, typically in the doctor’s office. This causes higher than normal blood pressure readings and is why we now use a 3 reading average rather than a single reading to diagnose hypertension. It also highlights the importance of at home blood pressure measurements to collect data you can share with your health care team. Check out this blog to ensure your at-home readings are accurate and reliable.

White coat syndrome helps us to understand how acute stress (which is a normal response) causes an increase in blood pressure. However, this rise in blood pressure is temporary and isolated events of anxiety or stress like this do not cause hypertension.

Chronic anxiety or GAD

Acute stress stands in contrast to ongoing anxiety; it is not due to an isolated life event or stressful situation. Generalized Anxiety Disorder (GAD) is defined as “feeling nervous, anxious or on edge” plus “not being able to stop or control worrying” more days than not each week. This kind of anxiety causes a baseline increase in our sympathetic nervous system (think “fight or flight”) which causes changes in our body predisposing us to having higher blood pressure. The full mechanism connecting anxiety to hypertension is complex, but the simple part is that there is a correlation between ongoing anxiety and hypertension.

Other contributing factors

While there are physiological mechanisms linking anxiety and high blood pressure, psychosocial factors also contribute to this correlation. Firstly, people with anxiety are more likely to engage in unhealthy lifestyle habits. This includes habits like smoking, drinking, increased eating and decreased exercise. We know these are modifiable risk factors for hypertension and likely contribute to the increased risk of high blood pressure.

Secondly, anxiety is a barrier to both diagnosis and treatment of hypertension. Stress, anxiety, and depression are the most reported reasons for hindering or delaying lifestyle modification, which is first line treatment for high blood pressure. This highlights the importance of not only physical but also psychological support in hypertensive patients with anxiety.

So what can you do?

1. Don’t stress about your numbers! Feeling anxious about your daily blood pressure reading will do more harm than good.

2. Treat your anxiety. Talk to your healthcare provider about your options! It’s thought that a combination approach of anti-hypertensive treatment & anti-anxiety treatment (typically a combination of medication and counseling) is more efficacious than either alone.

3. Introduce mindfulness. Start to make mindfulness and stress reduction part of your everyday life. It's a simple practice that has a scientifically proven impact on blood pressure and heart health.

Choose support

Your local pharmacy is a great resource for blood pressure management. They have free blood pressure kiosks available to monitor your numbers and knowledgeable pharmacists ready to answer your questions and provide support for healthy blood pressure.