What is the relationship between anxiety and hypertension?

From the Guidelines

Anxiety and hypertension should be managed concurrently, with a focus on lifestyle modifications and medications that address both conditions, such as ACE inhibitors or ARBs for hypertension, and SSRIs for anxiety, while considering the potential benefits of beta-blockers in specific cases. When considering the management of hypertension in patients with anxiety, it's essential to weigh the benefits and drawbacks of different medication classes. According to a 2022 study in the journal Hypertension 1, beta-blockers may be a good choice for certain patients, particularly those with excessive pressor response to exercise and mental stress, or hyperkinetic heart syndrome. However, their use should be individualized based on the patient's specific medical comorbidities. Some key considerations for managing anxiety and hypertension include:

• Lifestyle modifications, such as regular exercise, stress reduction techniques, and a healthy diet low in sodium
• Medications, such as ACE inhibitors like lisinopril (10-40mg daily) or ARBs like losartan (25-100mg daily), which are often preferred for hypertension management in anxious patients due to their fewer anxiety-inducing side effects
• SSRIs, like sertraline (50-200mg daily) or escitalopram (10-20mg daily), which can be safely used in hypertensive patients for anxiety management
• The potential benefits of beta-blockers in specific cases, as outlined in the 2022 study 1, which may include reducing excessive elevations of BP induced by physical exercise and/or mental stress. It's crucial to address both anxiety and hypertension simultaneously, as uncontrolled anxiety can make hypertension more difficult to manage, and vice versa. By taking a comprehensive approach to managing these interconnected conditions, healthcare providers can improve patient outcomes and reduce the risk of complications.

From the Research

Relationship Between Anxiety and Hypertension

• There is no direct evidence in the provided studies that discusses the relationship between anxiety and hypertension.
• However, some studies suggest that lifestyle modifications, such as stress management and promotion of adequate sleep patterns, can help prevent and treat hypertension 2.
• Regular physical exercise, body weight management, and healthy dietary patterns are also recommended for the prevention and treatment of hypertension 2, 3.
• Reducing blood pressure to less than 140/90 mm Hg is recommended to reduce the risk of all-cause and cardiovascular mortality in adults with hypertension 4, 5.

Treatment and Management of Hypertension

• First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 6, 5.
• First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 6, 4.
• The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 6.
• Thresholds for pharmacologic intervention and blood pressure goals differ according to various guidelines 5.

Lifestyle Interventions for Hypertension

• Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can help prevent and treat hypertension 2, 3.
• Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, that are comparable, superior, or complementary to other healthy lifestyle changes 3.
• Physical activity assessment and prescription are an excellent lifestyle behavior treatment option for all patients, including those with mild-moderate-risk patients with elevated blood pressure and blood cholesterol 3.