Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-26T22:14:40.525Z Has data issue: false hasContentIssue false
  • English
  • Français

A U-shaped relationship between systolic blood pressure and panic symptoms: the HUNT study

Published online by Cambridge University Press:  17 January 2012

S. J. C. Davies ,
O. Bjerkeset ,
D. J. Nutt  and
G. Lewis
S. J. C. Davies*
Affiliation:
Academic Unit of Psychiatry, University of Bristol, UK
O. Bjerkeset
Affiliation:
Research and Development, Levanger Hospital, Nord-Trøndelag Health Trust, Norway Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
D. J. Nutt
Affiliation:
Department of Neuropsychopharmacology, Imperial College, University of London, UK
G. Lewis
Affiliation:
Academic Unit of Psychiatry, University of Bristol, UK
*
*Address for correspondence: Dr S. J. C. Davies, Academic Unit of Psychiatry, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. (Email: simon.davies@bristol.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Previous studies on the relationship between blood pressure (BP) and psychological morbidity are conflicting. To resolve this confusing picture we examined the hypothesis that there is a non-linear relationship between panic and systolic BP (SBP) and explored the association of generalized anxiety symptoms with SBP.

Method

We used data from the population-based Nord-Trøndelag health study (HUNT) in which all 92 936 individuals aged ⩾20 years residing in one Norwegian county were invited to participate. Panic was assessed using one item from the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) and generalized anxiety with the remaining six items of this subscale. SBP was the mean of two measurements by an automatic device.

Results

A total of 64 871 respondents had SBP recorded (70%). Both unadjusted (n=61 408) and adjusted analyses provided evidence for a non-linear relationship between panic and SBP, represented by a U-shaped curve with a minimum prevalence of panic at around 140 mmHg. The relationship was strengthened after adjustment for confounders, with the quadratic term significantly associated with panic (p=0.03). Generalized anxiety symptoms were associated only with low SBP.

Conclusions

The U-shaped relationship between SBP and panic provides a unifying explanation for the separate strands of published literature in this area. The results support the hypothesis that high BP and panic disorder could share brainstem autonomic and serotonergic abnormalities. By contrast, generalized anxiety symptoms were more common only at lower BPs, suggesting that any biological link between panic and high BP does not extend to generalized anxiety.

Keywords

Anxietyepidemiologyhypertensionpanicpopulation
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 9 , September 2012 , pp. 1969 - 1976
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barrett-Connor, E, Palinkas, LA (1994). Low blood pressure and depression in older men: a population based study. British Medical Journal 308, 446–449.CrossRefGoogle ScholarPubMed
Barton, DA, Dawood, T, Lambert, EA, Esler, MD, Haikerwal, D, Brenchley, C, Socratous, F, Kaye, DM, Schlaich, MP, Hickie, I, Lambert, GW (2007). Sympathetic activity in major depressive disorder: identifying those at increased cardiac risk? Journal of Hypertension 25, 2117–2124.CrossRefGoogle ScholarPubMed
Carpenter, JR, Kenward, MG, Vansteelandt, S (2006). A comparison of multiple imputation and inverse probability weighting for analyses with missing data. Journal of the Royal Statistical Society: Series A (Statistics in Society) 169, 571–584.CrossRefGoogle Scholar
Davidson, K, Jonas, BS, Dixon, KE, Markovitz, JH (2006). Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Archives of Internal Medicine 160, 1495–1500.CrossRefGoogle Scholar
Davies, SJ, Esler, M, Nutt, DJ (2010). Anxiety – bridging the heart/mind divide. Journal of Psychopharmacology 24, 633–638.CrossRefGoogle ScholarPubMed
Davies, SJ, Ghahramani, P, Jackson, PR, Noble, TW, Hardy, PG, Hippisley-Cox, J, Yeo, WW, Ramsay, LE (1999). Association of panic disorder and panic attacks with hypertension. American Journal of Medicine 107, 310–316.CrossRefGoogle ScholarPubMed
Davies, SJ, Hood, SD, Argyropoulos, SV, Morris, K, Bell, C, Witchel, HJ, Jackson, PR, Nutt, DJ, Potokar, JP (2006). Depleting serotonin enhances both cardiovascular and psychological stress reactivity in recovered patients with anxiety disorders. Journal of Clinical Psychopharmacology 26, 414–418.CrossRefGoogle ScholarPubMed
Davies, SJ, Lowry, CA, Nutt, DJ (2007). Panic and hypertension: brothers in arms through 5-HT? Journal of Psychopharmacology 21, 563–566.CrossRefGoogle ScholarPubMed
Gafarov, VV, Gromova, HA, Gagulin, IV, Ekimova, YC, Santrapinskiy, DK (2007). Arterial hypertension, myocardial infarction and stroke: risk of development and psychosocial factors. Alaska Medicine 49, 117–119.Google ScholarPubMed
Glassman, AH, O'Connor, CM, Califf, RM, Swedberg, K, Schwartz, P, Bigger, Jr. JT, Krishnan, KR, van Zyl, LT, Swenson, JR, Finkel, MS, Landau, C, Shapiro, PA, Pepine, CJ, Mardekian, J, Harrison, WM, Barton, D, McIvor, M; Sertraline Antidepressant Heart Attack Randomized Trial (SADHEART) Group (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. Journal of the American Medical Association 288, 701–709.CrossRefGoogle ScholarPubMed
Grassi, G, Kiowski, W (2002). Is the autonomic dysfunction the missing link between panic disorder, hypertension and cardiovascular disease? Journal of Hypertension 20, 2347–2349.CrossRefGoogle ScholarPubMed
Hildrum, B, Mykletun, A, Stordal, E, Bjelland, I, Dahl, AA, Holmen, J (2007). Association of low blood pressure with anxiety and depression: the Nord-Trøndelag Health Study. Journal of Epidemiology and Community Health 61, 53–58.CrossRefGoogle ScholarPubMed
Jonas, BS, Franks, P, Ingram, DD (1997). 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. Archives of Family Medicine 6, 43–49.CrossRefGoogle ScholarPubMed
Kahn, HA, Medalie, JH, Neufeld, HN, Riss, E, Goldhurt, U (1972). The incidence of hypertension and associated factors: the Israel Ischemic Heart Disease Study. American Heart Journal 84, 171–182.CrossRefGoogle ScholarPubMed
Kaplan, NM (1997). Anxiety-induced hyperventilation. A common cause of symptoms in patients with hypertension. Archives of Internal Medicine 157, 945–948.CrossRefGoogle ScholarPubMed
Katon, W (1984). Panic disorder and somatization. Review of 55 cases. American Journal of Medicine 77, 101–106.CrossRefGoogle ScholarPubMed
Katon, W (1986). Panic disorder: epidemiology, diagnosis, and treatment in primary care. Journal of Clinical Psychiatry 47 (Suppl.), 21–30.Google ScholarPubMed
Langhammer, A, Johnsen, R, Holmen, J, Gulsvik, A, Bjermer, L (2000). Cigarette smoking gives more respiratory symptoms among women than among men. The Nord-Trøndelag Health Study (HUNT). Journal of Epidemiology and Community Health 54, 917–922.CrossRefGoogle Scholar
Long, JS, Freese, J (2006). Regression Models for Categorical Dependent Variables Using Stata, 2nd edn. Stata Press: College Station, TX.Google Scholar
Markovitz, JH, Matthews, KA, Kannel, WB, Cobb, JL, D'Agostino, RB (1993). Psychological predictors of hypertension in the Framingham Study. Is there tension in hypertension? Journal of the American Medical Association 270, 2439–2443.CrossRefGoogle Scholar
Markovitz, JH, Matthews, KA, Wing, RR, Kuller, LH, Meilahn, EN (1991). Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women. Journal of Hypertension 9, 399–406.CrossRefGoogle ScholarPubMed
Noyes, Jr. R, Clancy, J, Crowe, R, Hoenk, RP, Slymen, DJ (1978). The familial prevalence of anxiety neurosis. Archives of General Psychiatry 35, 1057–1074.CrossRefGoogle ScholarPubMed
Nutt, DJ (1989). Altered central alpha 2-adrenoceptor sensitivity in panic disorder. Archives of General Psychiatry 46, 165–169.CrossRefGoogle ScholarPubMed
Paterniti, S, Alperovitch, A, Ducimetiere, P, Dealberto, MJ, Lepine, JP, Bisserbe, JC (1999). Anxiety but not depression is associated with elevated blood pressure in a community group of French elderly. Psychosomatic Medicine 61, 77–83.CrossRefGoogle ScholarPubMed
Patten, SB, Williams, JV, Lavorato, DH, Campbell, NR, Eliasziw, M, Campbell, TS (2009). Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study. Psychosomatic Medicine 71, 273–279.CrossRefGoogle ScholarPubMed
Pemberton, J (1989). Does constitutional hypotension exist? British Medical Journal 298, 660–662.CrossRefGoogle ScholarPubMed
Perez, LH, Gutierrez, LA, Vioque, J, Torres, Y (2001). Relation between overweight, diabetes, stress and hypertension: a case-control study in Yarumal – Antioquia, Colombia. European Journal of Epidemiology 17, 275–280.CrossRefGoogle ScholarPubMed
Pilgrim, JA, Stansfeld, S, Marmot, M (1992). Low blood pressure, low mood? British Medical Journal 304, 75–78.CrossRefGoogle ScholarPubMed
Polyák, J (2001). How should we manage cardiovascular panic disorder accompanied by hypertension? Journal of Hypertension 19, (Suppl. 2), S64.Google Scholar
Rabkin, JG, Charles, E, Kass, F (1983). Hypertension and DSM-III depression in psychiatric outpatients. American Journal of Psychiatry 140,1072–1074.Google ScholarPubMed
Rainey, Jr. JM, Pohl, RB, Williams, M, Knitter, E, Freedman, RR, Ettedgui, E (1984). A comparison of lactate and isoproterenol anxiety states. Psychopathology 17 (Suppl. 1), 74–82.CrossRefGoogle ScholarPubMed
Shinn, EH, Poston, WS, Kimball, KT, St Jeor, ST, Foreyt, JP (2001). Blood pressure and symptoms of depression and anxiety: a prospective study. American Journal of Hypertension 14, 660–664.CrossRefGoogle ScholarPubMed
Snaith, RP, Zigmond, AS (1986). The hospital anxiety and depression scale. British Medical Journal (Clinical Research Edition) 292, 344.CrossRefGoogle ScholarPubMed
Sparrow, D, Garvey, AJ, Rosner, B, Thomas, HE Jr. (1982). Factors in predicting blood pressure change. Circulation 65, 789–794.CrossRefGoogle ScholarPubMed
Weissman, MM, Markowitz, JS, Ouellette, R, Greenwald, S, Kahn, JP (1990). Panic disorder and cardiovascular/cerebrovascular problems: results from a community survey. American Journal of Psychiatry 147, 1504–1508.Google ScholarPubMed
Wessely, S, Nickson, J, Cox, B (1990). Symptoms of low blood pressure: a population study. British Medical Journal 301, 362–365.CrossRefGoogle ScholarPubMed
White, WB, Baker, LH (1986). Episodic hypertension secondary to panic disorder. Archives of Internal Medicine 146, 1129–1130.CrossRefGoogle ScholarPubMed
Wiehe, M, Fuchs, SC, Moreira, LB, Moraes, RS, Pereira, GM, Gus, M (2006). Absence of association between depression and hypertension: results of a prospectively designed population-based study. Journal of Human Hypertension 20, 434–439.CrossRefGoogle ScholarPubMed
Wilkinson, DJ, Thompson, JM, Lambert, GW, Jennings, GL, Schwarz, RG, Jefferys, D (1998). Sympathetic activity in patients with panic disorder at rest, under laboratory mental stress, and during panic attacks. Archives of General Psychiatry 55, 511–520.CrossRefGoogle ScholarPubMed
Wittchen, HU, Essau, CA (1993). Epidemiology of panic disorder: progress and unresolved issues. Journal of Psychiatric Research 27 (Suppl. 1), 47–68.CrossRefGoogle ScholarPubMed