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First Published Tuesday, 28 October 2008

Hypertension

Family doctors and psychiatrists should carefully monitor the heart health of patients with anxiety disorders, Dr Simon Bacon told the Canadian Cardiovascular Congress 2008, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.


People with anxiety disorders are four times more likely to develop high blood pressure (hypertension) over one year than those of us who are anxiety free,” says Dr Bacon, a Heart and Stroke Foundation researcher at the Montreal Heart Institute. “Hypertension is a leading risk factor for stroke and heart disease.


Anxiety disorders are among the most common of all forms of mental illness, according to Dr Bacon. People affected frequently (often daily) experience intense feelings of fear and distress that are typically out of proportion to the actual threat or danger. They also tend to disrupt daily functioning, including personal relationships and the ability to work. They include general anxiety disorder, panic disorder, obsessive compulsive disorder, and social phobia.


Anxiety can cause increases in your blood pressure and heart rate. If it is persistent, those effects could be damaging,” says Heart and Stroke Foundation researcher and spokesperson Dr Brian Baker. “While we still need more understanding about how anxiety is associated with sustained high blood pressure, it is important that blood pressure is regularly monitored in people with anxiety disorders and that therapy – including anxiety management – is considered.


Dr Bacon says that anxiety can lead to unhealthy lifestyle choices, including poor diet, smoking, and physical inactivity, which can also increase a person’s overall risk for heart disease and stroke.


In the general population, at any point in time, anxiety disorders affect approximately 12 per cent of people,” says Dr Bacon. “And, anxiety disorders are generally twice more common among women than among men.


Dr Bacon’s research followed 185 patients with normal blood pressures for one year. The mean age of the patients was 58 years; 39 per cent were women, and 61 per cent were men. Sixteen per cent of patients had an anxiety disorder and 14 per cent had a mood disorder. Mood disorders include major depression, minor depression, and dysthymia.


Each patient underwent a structured psychiatric interview and provided information about their health. At the end of one year Dr Bacon again collected information about participants’ health.


Four per cent of the subjects without an anxiety disorder developed high blood pressure. However, 14 per cent of those who had an anxiety disorder developed hypertension.


The increase in high blood pressure did not apply to patients with mood disorders. “Our study also showed that patients who developed mood disorders were not at a higher risk of developing hypertension,” says Dr Bacon.


It is possible to have both,” says Dr Bacon. “It is very common to be depressed and anxious. But our study separated them out and found – at least over one year – that anxiety is a major culprit in hypertension.


Depression has a pronounced but indirect effect on the development of hypertension. People who are depressed tend to exercise less and make unhealthy lifestyle choices, according to Dr Bacon.


But anxiety may create a direct, physiological response – a shock to the nervous system:


  • Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least six months and can get worse if they are not treated.
  • Anxiety disorders commonly occur along with other mental or physical illnesses, including depression, alcohol, or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.
  • Effective therapies for anxiety disorders are available. Most people with anxiety disorders lead productive, fulfilling lives. People who think they have an anxiety disorder should seek information and treatment right away.

One of the main messages here is that it is important to look after one’s mental health as much as one’s physical health,” says Dr Bacon. “If you have chronic anxious feelings, this could lead to worse heart health. There is no need to suffer – there are very good treatments out there.

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Laurin C, Lavoie KL, Arseneault A, Ditto B, Bacon SL. The Impact of Mood and Anxiety Disorders on the Development of Hypertension. Presentation 0494-087, CCC Toronto, Canada 2008 Oct 27


Johns Hopkins Health Alert

How High Blood Pressure Can Affect Your Memory

The most serious effects of untreated hypertension are well known: strokes, heart attacks, heart failure, kidney disease, and vision loss. But hypertension can contribute to lesser-known health conditions, including cognitive (thinking) impairments. In this Health Alert, Johns Hopkins explains how hypertension leads to thinking problems and provides advice.

Hypertension, particularly in mid-life, may be a major risk factor for cognitive decline, dementia, and Alzheimer’s disease. On the plus side, research is showing that treating hypertension may lower the risk.

How does hypertension lead to thinking problems? One obvious reason is that high blood pressure increases the risk of stroke by damaging blood vessels that carry blood to the brain. This damage leads to the buildup of plaques, and when one of these plaques ruptures, a blood clot forms. If this blood clot cuts off blood supply to brain cells responsible for memory or other cognitive functions, the death of these cells can lead to impairments in thinking ability.

But researchers are starting to find that hypertension has a more insidious effect on the brain — that is, you don’t need to have a full-blown stroke for hypertension to do its damage. Brain scans show that individuals with hypertension are more likely to have brain lesions, called white matter hyperintensities (WMHs), than people with normal blood pressure. And the greater the number of these WMHs, the higher the risk of cognitive problems like dementia and Alzheimer’s disease.

So what are WMHs, and how do they affect your thinking? Your brain has two layers: an outer layer of gray matter that is packed with brain cells that process information, and an inner layer of white matter that contains nerve fibers that transmit information between brain cells. Hypertension-related buildup of plaque reduces blood flow to nerve fibers in the white matter, and the insufficient blood flow causes decay of the nerve fibers’ myelin sheaths, which are necessary for transmittal of information.

What can you do? Research indicates that gaining control of your blood pressure can reduce your risk of dementia. There is also some evidence that lowering blood pressure reduces the occurrence of new WMHs. The study looked only at people who were taking an ACE inhibitor in combination with a thiazide diuretic. But those taking this drug combination had fewer and smaller new WMHs after three years than those who received a placebo. More research is needed, however, to find out whether other blood pressure medications have the same effect.

Posted in Hypertension and Stroke on October 21, 2008



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