Anxiety may elevate BP in adolescents

Anxiety may contribute to an increased diastolic blood pressure (DBP) in adolescent children, suggests a study, noting the importance of screening for anxiety in this population.

“Our study demonstrates an association between anxiety and elevated DBP in adolescent children,” the researchers said. “Screening adolescents for anxiety should be a part of the routine evaluation of adolescent children.”

Two hundred adolescents (aged 12‒18 years) referred to the nephrology clinic participated in this study. Elevated BP was characterized by either systolic BP (SBP) or DBP measurement above the 95th percentile for age, height, and sex.

The researchers assessed participants for anxiety using the validated Screen for Child Anxiety Related Disorders (SCARED) questionnaire filled independently by the child (SCARED-C) and parent (SCARED-P) evaluating the child.

Of the SCARED-P-positive respondents, 31 (53 percent) had elevated BP compared with only 27 (19 percent) in the SCARED-P-negative group (p=0.03). Twenty-five (43 percent) of SCARED-P-positive participants also had increased DBP relative to 31 (28 percent) of SCARED-P-negative individuals (p=0.003). [J Hypertens 2024;42:644-649]

The mean DBP in the SCARED-P-positive group was higher than that in the SCARED-P-negative group (78.4 vs 74.9 mm Hg; p=0.03).

In subgroup analysis of adolescents not treated with BP medications, both SCARED-P (79.0 mm Hg) and SCARED-C (77.1 mm Hg) positive groups had higher DBP compared with SCARED-P (73.6 mm Hg) and SCARED-C (73.0 mm Hg) negative groups.

Mechanisms

“Anxiety might increase BP through multiple mechanisms, including sympathetic activity, plasma renin activity, abnormal lipid metabolism, hypothalamic–pituitary–adrenal dysfunction, and others,” the researchers said. [Hippokratia 2015;19:99-108; Clin Sci (Lond) 1979;57(Suppl 5):229s-231s; J Psychosom Res 2002;53:865-871; Am J Physiol Regul Integr Comp Physiol 2015;309:R1309-1325]

In the short-term, BP can increase in people with anxiety as usually observed in white coat hypertension in children. Increased sympathetic activation in this setting leads to heightened peripheral vascular resistance, resulting in elevated BP. [Am J Hypertens 2001;14:855-860; J Pediatr 2000;137:493-497; Arch Intern Med 2008;168:2459-2465; Circulation 1999;99:2192-2217]

Long-term anxiety can reduce vascular variability, damage endothelial cells, increase atherosclerosis risk, and bring about hypothalamic‒pituitary‒adrenal dysfunction. Such dysfunction leads to greater steroid hormone secretion, resulting in water and sodium retention, which then causes elevated BP. [J Psychosom Res 2002;53:865-871; J Clin Invest 2004;114:805-812; J Hypertens 2010;28:543-550]

“Another factor is an unhealthy lifestyle, which is common among anxious people, such as unhealthy eating, smoking, alcohol use, and lack of exercise,” the researchers said. “The role of those factors and mechanisms in children with anxiety has not been studied.” [Atherosclerosis 2005;178:339-344]

The current study was limited by its small sample size, the absence of data on lifestyle preferences, and the use of automatic BP measurements. In addition, diagnosis was based on BP measurements on the day of the clinic visit.

“Future studies should include a larger cohort size, the use of ambulatory BP monitoring, a more robust assessment of anxiety, and patients in general paediatric practices,” according to the researchers.