Anxiety as an Important Factor

In the discussion of the secondary causes of hypertension, one important factor was not mentioned: anxiety. Anxiety disorders often present physically, even without manifest anxiety, as tachycardia, shortness of breath, cardialgia, dizziness, multifocal pain, high temperature, and arterial hypertension (1). In somatized anxiety attacks, systolic blood pressure can reach 300 mmHg, and diastolic blood pressure 120 mmHg.

The explanation for this is as follows: latent feelings of anxiety put the autonomic nervous system, muscle tone (pains), and the thyroid (hyperthyroidism) into “high gear.” Anxiety should therefore be considered in every case of resistant high blood pressure, particularly when other equivalents of anxiety such as nocturnal waking with sweating and craving for food are identified. The authors even lump together high blood pressure and anxiety under the heading of “white-coat hypertension.”

In these patients, blood pressure values usually fall significantly after discussion of their anxiety, of which they were not previously conscious, and its biographical origin. Anger or grief can also be associated with anxiety. The decisive factor is to put a name to the emotion (“Your high blood pressure is anxiety/anger/etc.”) and to understand it.

Only after diagnosis and treatment have addressed the emotional component of hypertension, and receptive methods have been exhausted, should the invasive procedure of renal denervation be considered.

DOI: 10.3238/arztebl.2012.0311b

Dr. med. Mechthilde Kütemeyer

Fichtenstraße 52, 68535 Neckarhausen, kuete@arcor.de

Conflict of interest statement

The author declares that no conflict of interest exists.