Blood pressure and mental health: Study finds cardiovascular link

• Apart from affecting psychological well-being, mental health conditions can also interfere with the body’s autonomic functions, creating physiological problems.
• Previous studies have found that people with mental health conditions commonly experience reduced heart rate variation (HRV), which can indicate a poor stress response.
• A new systematic review draws a link between mental illness and widely fluctuating blood pressure, which can lead to cardiovascular disease.

A new study has found that people with mental health conditions such as depression or anxiety may be more prone to experience cardiovascular problems.

Researchers behind this systematic review, published in the journal BioMedical Engineering, observed that mental health conditions may have an impact on autonomic functions, which may cause blood pressure to widely fluctuate.

Research so far has on the relationship between blood pressure variability (BPV) and mental illness has been limited. This is important as BPV has been associated with coronary disease.

The study also adds to existing research establishing a link between mental health and physical well-being.

Mental health and dysregulated autonomic function

The autonomic nervous system (ANS) is a complex network of cells that regulate involuntary physiologic processes like maintaining a constant internal temperature, regulating breathing patterns, keeping blood pressure steady, and moderating the heart rate.

Autonomic dysfunction is associated with an increased risk of cardiovascular disease.

Doctors assess heart rate variability (HRV), which is controlled by the ANS, to see the duration in time between heartbeats. Having a constantly changing heart rate has been linked with having a healthy regulatory system.

Correspondingly, a number of studies have reported an association between reduced HRV and depression and anxiety disorders — including generalized anxiety disorder, social anxiety disorder, panic disorder, and post-traumatic stress disorder.

What the study found

For their review, the researchers searched four electronic databases for studies investigating BPV in individuals with mental illness who did not have hypertension. They found 12 studies that met the criteria.

Of the 12 studies, seven measured ultrashort term BPV (beat-to-beat blood pressure measurement over seconds to minutes), three measured short-term BPV (blood pressure fluctuations that occur over a 24-hour time period), and two measured long-term BPV (fluctuations that occur over days, weeks, or even years).

Five of the studies assessed BPV in adults aged 55 and older while the remaining studies assessed BPV in adults between the ages of 18 and 46.

People with depression or anxiety had high BPV in the studies that measured short-term BPV. The studies measuring ultra-short-term BPV also found a significant association between BPV and mental illness.

The two studies that measured long-term BPV had mixed results, meaning the association between mental health conditions and long-term BPV is less clear.

The researchers from the University of South Australia and several universities in Malaysia write that early therapeutic intervention for mental illness “may prevent diseases associated with autonomic dysregulation and reduce the likelihood of negative cardiac outcomes.”

Does treatment make a difference?

Dr. Richard Wright, a cardiologist at Providence Saint John’s Health Center, told Medical News Today that the systematic review illustrates how mental illness, “at least in theory”, makes patients “more prone to having cardiac issues that we normally only think would be attributable to atherosclerosis, and hypertension, old age, [etc.].”

“I think that’s the main importance of this kind of an analysis: to point out that there are physical ramifications of these emotional issues,” he said.

Dr. Wright said additional research on what to do about the association between mental health and cardiovascular health would be helpful for healthcare practitioners.

“If you’re chronically depressed and you have these issues where the autonomic nervous system is messed up, do you get better if your depression goes away?” he asked.

Specifically, he said would like to see studies on whether BPV variability decreases with mental health treatments like talk therapy, meditation, or medication.

Need for more integrated care

Dr. Cristen Wathen, an assistant professor in the counseling department at Palo Alto University, wasn’t surprised by the conclusions the researchers drew from their systematic review.

“When we are consistently in chronic stress, which is typical of people who have been diagnosed with [anxiety and depression], then our bodies are releasing stress hormones, cortisol, epinephrine,” she told MNT.

“If we’re in that constant state of chronic stress [due to anxiety and depression], then that’s going to relate to our physical health.”
— Dr. Cristen Wathen

Dr. Wathen said she would have liked to have seen more detailed insight into the study participants’ races and socioeconomic statuses.

“There’s so much that’s related to poverty, oppression, trauma, like generational trauma, and access to healthcare, that also can lead to more experiences of chronic stress,” she pointed out.

Even without that information, however, Dr. Wathen felt the study highlighted a weakness of the American healthcare system.

“It speaks to the need for there to be more integrated care and coordination between mental health professionals and medical professionals because of how related our physical health and our mental health is,” she said.

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