Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies

Background Epidemiological studies have repeatedly investigated the association between anxiety and hypertension. However, the results have been inconsistent. This study aimed to summarize the current evidence from cross-sectional and prospective studies that evaluated this association. Methods Seven common databases were searched for articles published up to November 2014. Cross-sectional and prospective studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratios or hazard ratios, and 95% confidence intervals (CIs) were extracted or calculated by the authors. The pooled odds ratio was calculated separately for cross-sectional and prospective studies using random-effects models. The Q test and I 2 statistic was used to assess heterogeneity. A funnel plot and modified Egger linear regression test were used to estimate publication bias. Results The search yielded 13 cross-sectional studies (n=151,389), and the final pooled odds ratio was 1.18 (95% CI 1.02–1.37; PQ<0.001; I2=84.9%). Eight prospective studies with a total sample size of 80,146 and 2,394 hypertension case subjects, and the pooled adjusted hazard ratio was 1.55 (95% CI 1.24–1.94; PQ<0.001; I2=84.6%). The meta-regression showed that location, diagnostic criteria for anxiety, age, sex, sample size, year of publication, quality, and years of follow-up (for prospective study) were not sources of heterogeneity. Conclusion Our results suggest that there is an association between anxiety and increased risk of hypertension. These results support early detection and management of anxiety in hypertensive patients.

• Publication year

  2015

• Venue

  Neuropsychiatric Disease and Treatment

• Publication date

  2015-04-22

• Fields of study

  Medicine, Psychology

• Identifiers
  DOI 10.2147/NDT.S77710PMID 25960656PMCID 4411016
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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  2014cited by this paper
• Hypertension and risk of depression in the elderly: a meta-analysis of prospective cohort studies

  2014influential reference
• The Impact of Mood and Anxiety Disorders on Incident Hypertension at One Year

  2014cited by this paper
• Associations between mental disorders and subsequent onset of hypertension.

  2014influential reference
• The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses

  2014cited by this paper
• Anxiety in the “Age of Hypertension”

  2014cited by this paper
• Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

  2014cited by this paper
• The Autonomic Nervous System and Hypertension

  2014cited by this paper
• Depression and anxiety are associated with a diagnosis of hypertension 5 years later in a cohort of late middle-aged men and women

  2013cited by this paper
• Anxiety disorder is associated with nocturnal and early morning hypertension with or without morning surge: ambulatory blood pressure monitoring.

  2012cited by this paper
• Symptoms of depression and anxiety and adherence to antihypertensive medication.

  2012cited by this paper
• Anxiety, depression and autonomic nervous system dysfunction in hypertension.

  2012cited by this paper
• Prevalence of distress, comorbid conditions and well being in the general population.

  2011influential reference
• The association between mood and anxiety disorders with vascular diseases and risk factors in a nationally representative sample.

  2011influential reference
• Epidemiology of Anxiety Disorders in the Australian General Population: Findings of the 2007 Australian National Survey of Mental Health and Wellbeing

  2011cited by this paper
• Serine/threonine kinase 39 is a candidate gene for primary hypertension especially in women: results from two cohort studies in Swedes

  2011cited by this paper
• Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway

  2011cited by this paper
• Mental illness surveillance among adults in the United States.

  2011cited by this paper
• Generalized Anxiety and Major Depressive Disorders, Their Comorbidity and Hypertension in Middle-Aged Men

  2010influential reference
• The association among hypertension and reduced psychological well-being, anxiety and sleep disturbances: a population study.

  2010influential reference
• Human models in acute and chronic stress: Assessing determinants of individual hypothalamus–pituitary–adrenal axis activity and reactivity

  2010cited by this paper
• Anxiety and risk of incident coronary heart disease: a meta-analysis.

  2010cited by this paper
• Hypertension Awareness and Psychological Distress

  2010cited by this paper
• Association between the sympathetic firing pattern and anxiety level in patients with the metabolic syndrome and elevated blood pressure

  2010cited by this paper
• Association between Anxiety or Depressive Symptoms and Arterial Hypertension, and Their Impact on the Quality of Life

  2010influential reference
• The Association between Hypertension and Depression and Anxiety Disorders: Results from a Nationally-Representative Sample of South African Adults

  2009influential reference
• Depression Is Associated With Decreased Blood Pressure, but Antidepressant Use Increases the Risk for Hypertension

  2009cited by this paper
• [A case-control study on depression and anxiety in hypertensive patients].

  2008influential reference
• The misdiagnosis of hypertension: the role of patient anxiety.

  2008cited by this paper
• Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation.

  2008cited by this paper
• The impact of perceived hypertension status on anxiety and the white coat effect

  2007cited by this paper
• Interactions among higher trait anxiety, sympathetic activity, and endothelial function in the elderly.

  2007cited by this paper
• Mental Disorders and Hypertension: Factors Associated With Awareness and Treatment of Hypertension in the General Population of Germany

  2006influential reference
• Association of low blood pressure with anxiety and depression: the Nord-Trøndelag Health Study

  2006cited by this paper
• Increased risk of hypertension in patients with bipolar disorder and patients with anxiety compared to background population and patients with schizophrenia.

  2006cited by this paper
• Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease.

  2005cited by this paper
• Hypertension and depression.

  2005cited by this paper
• Anti-stress and anti-anxiety effects of centrally acting angiotensin II AT1 receptor antagonists.

  2005cited by this paper
• Antianxiety treatment in patients with excessive hypertension.

  2005cited by this paper
• The relationship between hypertension and anxiety or depression in Hong Kong Chinese.

  2005cited by this paper
• Global burden of hypertension: analysis of worldwide data.

  2005cited by this paper
• Decreased susceptibility to renovascular hypertension in mice lacking the prostaglandin I2 receptor IP.

  2004cited by this paper
• Interactions Between Autonomic Nervous System Activity and Endothelial Function: A Model for the Development of Cardiovascular Disease

  2004cited by this paper
• Depression and anxiety in the developing world: is it time to medicalise the suffering?

  2004cited by this paper
• Psychosocial factors and risk of hypertension: the Coronary Artery Risk Development in Young Adults (CARDIA) study.

  2004cited by this paper
• The sympathetic nervous system and hypertension: recent developments.

  2004cited by this paper
• Psychosomatic aspects of arterial hypertension in women.

  2004cited by this paper
• Measuring inconsistency in meta-analyses

  2003cited by this paper
• Effects of angiotensin II and its receptor antagonists on motor activity and anxiety in rats.

  2003cited by this paper
• Anxiety or/and Depression in Patients with Hypertension

  2003cited by this paper
• Quantifying heterogeneity in a meta‐analysis

  2002cited by this paper
• Blood pressure and symptoms of depression and anxiety: a prospective study.

  2001cited by this paper
• Trajectory of Psychological Risk and Incident Hypertension in Middle-Aged Women

  2001cited by this paper
• Psychologic factors as precursors to hypertension

  2001cited by this paper
• Quality of life in individuals with anxiety disorders.

  2000cited by this paper
• Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy.

  1999cited by this paper
• Assessing the influence of a single study in the meta-anyalysis estimate

  1999cited by this paper
• Anxiety but not depression is associated with elevated blood pressure in a community group of French elderly.

  1999cited by this paper
• Bias in meta›analysis detected by a simple, graphical test

  1998cited by this paper
• Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.

  1997cited by this paper
• Bias in meta-analysis detected by a simple, graphical test

  1997influential reference
• Psychological predictors of hypertension in the Framingham Study. Is there tension in hypertension?

  1993cited by this paper
• Abnormalities in the hypothalamo-pituitary-adrenal axis in spontaneously hypertensive rats during development of hypertension.

  1989cited by this paper
• On Middle-aged Women

  1982cited by this paper
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