SPOILER ALERT! ~ Studies show an association between anxiety disorders and poor cardiovascular health. Cardiovascular diseases are the main cause of death among individuals with mental illness, including depression and anxiety disorders. ~ Measures of heart rate and blood pressure variability help understand the link between anxiety disorders and poor cardiovascular health ~ High heart rate variability (HRV) indicates a healthy adjustment to stress while reduced heart rate variability reflects poor adjustment to stress and higher risk of developing medical conditions. ~ Reduced HRV is seen in anxiety disorders, particularly, generalized anxiety disorder, panic disorder, post-traumatic stress disorder and social anxiety. ~ High blood pressure variability (BPV) is associated with increased release of stress hormone, which in turn is linked to coronary events ~ Panic disorder is associated with the absence of normal nocturnal dip in BP which is linked with hyperarousal and sleep difficulties. Panic disorder, GAD and depression are associated with high BPV High BPV at rest has been observed in panic disorder.
There is a wide body of research indicating that the presence of mental illness is associated with increased mortality due to health problems. Cardiovascular diseases figure as the most prominent cause of death among individuals with mental illness through impaired autonomic function.
The autonomic system consists of the sympathetic and parasympathetic systems and is involved in the regulation of essential bodily systems that are outside of voluntary control. These include breathing, digestion, heart rates, and blood pressure to name just a few.
Heart Rate and Anxiety Disorders
Measuring heart rate variability (HRV) is one recent method used to assess autonomic functions. It is an assessment of the beat to beat variation in the heart with high variability suggesting a healthy autonomic system that is able to fully adjust to environmental and psychological challenges.
By contrast reduced HRV indicates that the body’s response to stress is not optimal potentially allowing stress to exert negative effects on the body, including increasing the risk to develop medical conditions.
Reduced HRV has been reported among individuals with depression and anxiety disorders, including generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder and panic disorder. Furthermore, low HRV in patients with psychological disorders has been associated with poorer cardiovascular health and a variety of vascular diseases.
Blood Pressure and Anxiety Disorders
Similarly, measures of blood pressure variability (BPV) represent another index of autonomic regulation. Indeed, BPV reflects blood pressure fluctuations within a given period (e.g., several minutes, 24 hours, years, etc…depending on the measurement). Unlike heart rates, high fluctuations in blood pressure have been associated with coronary events.
Blood pressure changes occur as a result of the person’s reactivity to emotional stimuli such as mental state or stress, and behavioral factors (e.g., physical activity, sleep cycles, and even postural changes). It has been reported that people with mental illness exhibit high BPV, which in turn has been linked to increased cardiovascular risks and organ damage.
More pertinently, high and irregular BPV have been observed in patients with anxiety disorders. For example, panic disorder patients do not exhibit the normal dip in blood pressure at night (i.e., in a healthy individual, blood pressure dips at night to favor sleep and surges in the morning). This irregularity is associated with sleep difficulty and hyperarousal in panic disorder, since there is an associated increase in the release of stress hormones upon sleep onset.
Similarly, high BPV has been reported among individuals with generalized anxiety disorder and late onset depression, but not in major depression. More telling is the finding that blood pressure at rest in individuals with anxiety and panic disorder is higher than normal.
These results are another indication of sympathetic activation (i.e., arousal) and deactivation of vagal activity, which reflects the activation of the parasympathetic system. The latter contributes to calming and relaxing the body.
Reference:
Shahimi NH, Lim R, Mat S, Goh CH, Tan MP, Lim E. Association between mental illness and blood pressure variability: a systematic review. Biomed Eng Online. 2022 Mar 21;21(1):19. doi: 10.1186/s12938-022-00985-w. PMID: 35313918; PMCID: PMC8935841.