Anxiety is one of the most common mental health issues in North America, affecting around 20% of adults¹. It causes significant impacts on health and quality of life and is linked with multiple other health conditions¹. 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 the physical symptoms may cause or worsen anxiety or the anxiety may worsen the physical symptoms. We know that 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% of adults) and is the leading cause of preventable death and disability in Canada. Hypertension is multifactorial in its cause, from genetics (or a family history of cardiovascular disease) to lifestyle choices and even psychosocial factors like stress and anxiety.  We know that when we make changes 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 office². 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 pressure². However, this rise in blood pressure is temporary and isolated events of anxiety or stress like this do not cause hypertension².

Chronic Anxiety or GAD

Acute stress is in contrast to ongoing anxiety that 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 week³. 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 pressure¹.  The full mechanism connecting anxiety to hypertension is complex, but the simple part is that there is a correlation between  ongoing anxiety and hypertension¹.

Other Contributing Factors

While there are physiological mechanisms linking anxiety and high blood pressure, there are psychosocial factors that also contribute to this correlation. The first is,  people with anxiety are more likely to engage in unhealthy lifestyle habits¹. This includes things like smoking, drinking, increased eating and decreased exercise¹. We know that 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 hypertension⁴. Stress, anxiety, and depression are the most commonly reported reasons for hindering or delaying lifestyle modification, which is first line treatment for high blood pressure⁴. This highlights the importance of not only physical but also psychological support in hypertensive patients with anxiety.