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

Abstract

Yu Pan,1,2,* Wenpeng Cai,1,* Qi Cheng,3,* Wei Dong,1 Ting An,4 Jin Yan1 1Department of Psychology and Mental Health, Second Military Medical University, Shanghai, 2Department of Psychology, Peoples Liberation Army General Hospital, Beijing, 3Department of Child and Adolescent Behavioral Medicine, The 102 Hospital of PLA, Changzhou, 4Department of Internal Medicine, The PLA Second Artillery Force General Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work 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 I2 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. Keywords: human, epidemiological association, anxiety disorder, hypertension, meta-analysis