THE RELATIONSHIP OF HIGH BLOOD PRESSURE, ANXIETY AND STRESS: AN INTEGRATIVE LITERATURE REVIEW

Oliveira, Ana Raquel de; Bezerra, Hannah Carla de Jesus; Gaudêncio, Edmundo de Oliveira; Batista, José Roniere de Morais; Lucena, Maria do Socorro Roberto de

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ARTICLE • Psicol. Estud. 26 • 2021 • https://doi.org/10.4025/psicolestud.v26i0.46083 copy

THE RELATIONSHIP OF HIGH BLOOD PRESSURE, ANXIETY AND STRESS: AN INTEGRATIVE LITERATURE REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The objective of this study was to conduct an integrative literature review to verify which studies addressed the relationship between stress and anxiety in hypertensive patients. To do so, the study was carried out at the bases PsycINFO, Portal da Capes, Scielo and Medline BVS-PSI, using the descriptors ‘arterial hypertension’ and ‘stress’ and ‘anxiety’, and their correspondents in the English language ‘arterial hypertension’ and ‘stress’ and ‘anxiety’ and Spanish ‘hypertension’ and ‘anxiety’, considering the last six years (2013 to 2018). The results were grouped into three categories: a) The impact caused by the diagnosis of chronic non communicable diseases, b) Psychological factors associated with arterial hypertension and c) Deconstructing the dichotomy: physical health vs. mental health. The search resulted in the inclusion of 14 empirical studies. The results showed that anxiety and stress, in addition to depression, may present as modulatory aspects of arterial hypertension. Therefore, it is considered necessary the demystification of the cartesian logic between mind and body, so that actions of integral care of the subjects and promotion of health are carried out. It is hoped that the results obtained reaffirm the importance of considering the psychological and emotional aspects in chronic diseases, and that future studies with different designs be developed in the other areas of health, besides the medical area.

Keywords:
Anxiety; stress; arterial hypertension

Authors/Year	Design	Sample	Instruments	Main findings
Águila et al. (2013)Águila, F. J., García, J. D. M., Navarrete N. N., Cortés, J. L. R., Torres, C. F., & Alonso, J. J. (2014). Ansiedad, depresión y su implicación en la hipertensión arterial resistente. Hipertensión y Riesgo Vascular, 31(1), 7-13. doi: 10.1016/j.hipert.2013.08.001 https://doi.org/10.1016/j.hipert.2013.08... ;	Quantitative	40 patients, age group 33 to 77	State -Trait Anxiety Inventory (STAI- R); Beck Depression Inventory (BDI)	There was a significant correlation between Blood Pressure, anxiety and depression in male patients.
Bacon, Campbell, Arsenault, & Lavoie (2014Bacon, S. L., Campbell, T. S., Arsenault, A., & Lavoie, K. L. (2014). The impact of mood and anxiety disorders on incident hypertension at one year. International Journal of Hypertension, 2014, 1-7. doi: 10.1155/2014/953094 https://doi.org/10.1155/2014/953094... )	Quantitative	197 people, age group ≥18 years (M=58)	Self-report questionnaire; Psychiatric interview (PRIME- MD)	Patients diagnosed with Anxiety Disorder were more likely to develop Arterial Hypertension when compared to those who did not have this diagnosis.
Balint et al. (2016Balint, E. M., Boseva, P., Schury, K., Guendel, H., Rottbauer, W., & Waller, C. (2016). High prevalence of post-traumatic stress in patients with primary hypertension. General Hospital Psychiatry, 38(1), 53-58. doi: 10.1016/j.genhosppsych.2015.10.002 https://doi.org/10.1016/j.genhosppsych.2... )	Quantitative	141 patients, unidentified age group.	German version of the Hospital Anxiety and Depression Scale (HADS-D, HADS-A); Trier Inventory for the Assessment of chronic stress (TICS-SSCS).	Patients diagnosed with Post-traumatic Stress Disorder had controlled blood pressure levels, despite high scores on the stress and anxiety scales.
Hernández Portela, Barbeito, Cabrera, & Castro (2013Hernández, M. G., Portela, R. G., Barbeito, T. O. T., Cabrera, J. R. C., & Castro, Y. D. (2013). Factores de riesgo de eventos coronarios agudos: importancia del factor psicosocial. Revista Ciencias Médicas, 17(3), 3-15. Recuperado de http://scielo.sld.cu/pdf/rpr/v17n3/rpr02313.pdf http://scielo.sld.cu/pdf/rpr/v17n3/rpr02... )	Quantitative	Study group= 19 cases. Control group = 38 cases.	Tests de vulnerabilidad al stress; Inventário de ansiedad rasgo-estado (IDARE).	The presence of psychosocial aspects stress, anxiety and depression were not considered as triggering factors for acute coronary events.
Kretchy, Owusu-Daaku, & Danquah (2014)Kretchy, I. A., Owusu-Daaku, F.T., & Danquah, S. A. (2014). Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. International Journal of Mental Health Systems, 8(25), 1-10. doi: 10.1186/1752-4458-8-25 https://doi.org/10.1186/1752-4458-8-25...	Quantitative	324 participants (under 18 and over 70 years)	Depression, Anxiety and Stress Scale (DASS) - 21	The chronic status of hypertensive patients manifested symptoms of anxiety, depression and stress.
László et al. (2016László, A., Tabák, Á., Kőrösi, B., Eörsi, D., Torzsa, P., Cseprekál, O., … Nemcsik, J. (2016). Association of affective temperaments with blood pressure and arterial stiffness in hypertensive patients: a cross-sectional study.BMC cardiovascular disorders,16(1), 158. doi:10.1186/s12872-016-0337-9 https://doi.org/10.1186/s12872-016-0337-... )	Not specified	173 patients (53 to 70 years)	Beck Depression Inventory (BDI); Hamilton Anxiety Scale (HAM- A).	Arterial Hypertension is significantly associated with anxious and depressive temperaments.
Li et al. (2016Li, R., Gao, X., Liu, B., Ge, H., Ning, L., Zhao, J., & Liu, J. (2016). Prospective cohort study to elucidate the correlation between occupational stress and hypertension risk in oil workers from Kelamayi City in the Xinjiang Uygur autonomous region of China. International journal of environmental research and public health, 14(1), 1-12. doi:10.3390/ijerph14010001 https://doi.org/10.3390/ijerph14010001... )	Quantitative	1354 workers, 715 males (52.8%); 639 females (47.2%)	Occupational Stress Inventory (OSI-R)	Increased occupational stress was associated with an increased risk of Hypertension.
Mushtaq & Najam (2014Mushtaq, M., & Najam, N. (2014). Depression, anxiety, stress and demographic determinants of hypertension disease. Pakistan journal of medical sciences, 30(6), 1293-8. doi: 10.12669/pjms.306.5433 https://doi.org/10.12669/pjms.306.5433... )	Quantitative	237 (30 to 65 years) Hypertensive group: 77 men and 60 women; Non-hypertensive group: 50 normotensive men and 50 women	Demographic information questionnaire; Depression, Anxiety and Stress Scale (DASS)	Depression, Anxiety and Stress were indicated as predictors for Arterial Hypertension, especially in the “high” level category.
Palagini et al. (2015Palagini, L., Bruno, R. M., Cheng, P., Mauri, M., Taddei, S., Ghiadoni, L, ... , Morin, C. M. (2015). Relationship between insomnia symptoms, perceived stress and coping strategies in subjects with arterial hypertension: psychological factors may play a modulating role. Sleep Medicine, 19(1), 108-115. doi: 10.1016/j.sleep.2015.09.026 https://doi.org/10.1016/j.sleep.2015.09.... )	Quantitative	330 female and male patients (Age group M= 56.6)	Beck Depression Inventory (BDI); Self-rating Anxiety Scale (SAS); State-Trait Anxiety Inventory (STAI)	Hypertensive patients with symptoms of insomnia were more stressed and with fewer coping strategies; anxiety and depression play a modulating role in these relationships (insomnia, hypertension and stress).
Schmieder, Grassi, & Kjeldsen (2014)Schmieder, R. E., Grassi, G., & Kjeldsen, S. E. (2013). Patients with treatment-resistant hypertension report increased stress and anxiety: a worldwide study. Journal of Hypertension, 31(3), 610-615. doi: 10.1097/HJH.0b013e32835d6e53 https://doi.org/10.1097/HJH.0b013e32835d...	Qualitative	4574 participants: treatment resistant group (2,649) and uncontrolled hypertension group (1,925)	Survey methodology: online survey	The diagnosis of Arterial Hypertension and the lack of blood pressure control lead to a high emotional burden for patients, who were more anxious and stressed.
Stein et al. (2014Stein, D. J., Aguilar-Gaxiola, S., Alonso, J., Bruffaerts, R., de Jonge, P., Liu, Z., … Scott, K. M. (2014). Associations between mental disorders and subsequent onset of hypertension. General Hospital Psychiatry, 36(2), 142-149.)	Not specified	52,095 people, age group ≥18 years	WHO Composite International Diagnostic Interview (now CIDI 3.0)	The psychopathological and psychiatric diagnosis of the population analyzed is associated with the subsequent diagnosis of Arterial Hypertension in a large part of the sample.
Tominaga et al. (2015)Tominaga, T. Matsushima, M., Nagata, T., Moriya, A., Watanabe, T., Nakano, Y., ..., Fujinuma, Y. (2015). Psychological impact of lifestyle-related disease disclosure at general checkup: a prospective cohort study. BMC Family Practicd, 16(60), 1-10. doi: 10.1186/s12875-015-0272-3. https://doi.org/10.1186/s12875-015-0272-...	Multimethod	503 patients, female (321) and male (182), aged between 40 and 75 years (M=62)	Self-administered questionnaire; State-Trait Anxiety Inventory (STAI)	Patients with abnormal levels in lifestyle-related disease markers (including Hypertension) scored significantly on the anxiety scale, which implies that there was a significant psychological impact, albeit in the short term.
Uceda, Fernández, Lópeza, & García-Vera (2013Uceda, I. M., Fernández, J. S., Lópeza, R. E., & García-Vera, M. P. (2013). Perfil emocional y cognitivo de la hipertensión arterial esencial mantenida contra Normotensão. Clínica e Saúde, 24(2), 1-15.)	Multimethod	94 participants, aged from 38 to 77 years. Normotensive group n=37; HTA-E group: n=57	Structured interview; Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI-II); Survey of Recent Life Experiences (SRLE).	Hypertensive people had higher scores in the anxiety scales, as well as in the depression and stress inventories (despite not presenting significant statistics), when compared to the group of normotensive people.
Vanhoof et al. (2014Vanhoof, J. M. M., Delcroix, M., Vandevelde, E., Denhaerynck, K., Wuyts, W., Belge, C., & Dobbels, F. (2014). Emotional symptoms and quality of life in patients with pulmonary arterial hypertension. The Journal of Heart and Lung Transplantation, 33(8), 800-808. doi: 10.1016/j.healun.2014.04.003 https://doi.org/10.1016/j.healun.2014.04... )	Quantitative	101 patients (73% women)	Health Survey (SF-36); Depression, Anxiety and Stress Scale (DASS)	Symptoms of stress, depression and anxiety affect about 50% patients diagnosed with Pulmonary Arterial Hypertension.

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