Psychiatric disorders and cardiovascular disease: anxiety, depression and hypertension

Whereas the association of depression with cardiovascular disease is well established, the literature relating to anxiety disorders and cardiovascular disease is much less developed. There have been several studies which have examined the association of anxiety disorders with cardiovascular diagnoses, in particular with hypertension, an independent risk factor both for myocardial infarction and for stroke. Here mechanisms proposed for the association of depression and cardiovascular disease based on cytokines, platelets, the autonomic nervous system and illness behaviour are reviewed. The evidence linking anxiety disorders and cardiovascular disease is then examined. Focussing more specifically on hypertension, data on the associations of abnormal blood pressure with anxiety disorders and with depression are reviewed. While there is considerable evidence for associations of hypertension with panic disorder and some evidence for associations of hypertension with generalized anxiety disorder and depression, associations of low blood pressure with measures of psychological dysfunction have also been reported. Finally the evidence relating to the aetiology of the association of panic disorder with hypertension is explored, again relating to autonomic nervous system dysfunction, cytokines and platelets. A putative neurobiological model of panic and hypertension Simon J.C. Davies, Sean D. Hood, David Christmas et al. 2 involving autonomic nervous system dysfunction modulated by the neurotransmitter serotonin is presented.