Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension

A Bibliometric Analysis of hypertension and anxiety from 2004 to 2022

BACKGROUND

A growing body of clinical evidence points to an association between hypertension and anxiety, but the mechanisms by which the two occur are unclear. This article aims to explore possible common influences and associations between hypertension and anxiety.

METHODS

We searched for publications on hypertension and anxiety from January 01, 2004 to December 31, 2022 in Web of Science and performed bibliometrics using CiteSpace, VOSviewer, Scimago Graphica and Gephi.

RESULTS

A total of 3216 related articles were retrieved from the Web of Science database. After screening, 3051 articles were included. The number of published articles has increased over the past 19 years. The United States has more researches in this area and has strong collaborative relationships with other countries, which gives it some credibility and authority. The words that appear in the burst keywords are gender, age, obesity, depression, panic disorder, pregnancy induced hypertension, coronary heart disease, chronic kidney disease, and pituitary adrenal axi, which are co-related with hypertension and anxiety.

CONCLUSION

There is a link between hypertension and anxiety, and the 2 influence each other, usually in a positive way. Common influences on hypertension and anxiety include age, gender, obesity, depression, panic attacks, pregnancy, coronary heart disease and chronic kidney disease. Recent research hotspots have focused on population aging and comorbidities. Future research hotspots are likely continue to focus on influencing factors, clinical research and prognosis.

Associations between social participation and psychological distress among older adults with hypertension in rural China: The mediating role of social capital

Psychological distress in older adults with hypertension in rural China significantly impacts their families and society. This study aims to explore how social participation affects psychological distress among older adults with hypertension in rural China, focusing on the mediating role of social capital. A total of 950 respondents completed surveys measuring social participation based on the frequency of social, recreational, and literary activities, the Resource Generator China scale, and the Kessler Psychological Distress Scale. Structural equation modeling was used to analyze the relationships between the variables. The results showed that social participation significantly affects psychological distress, with social capital mediating this relationship. The indirect effect of social capital accounted for 61.0% of the total effect. These findings suggest targeted interventions in social participation and social capital to reduce psychological distress among rural elderly individuals with hypertension in China.

Hypertension Management in Women With a Multidisciplinary Approach

Current clinical practice guidelines were established by several organizations to guide the diagnosis and treatment of hypertension in men and women in a similar manner despite data demonstrating differences in underlying mechanisms. Few publications have provided a contemporary and comprehensive review focused on characteristics of hypertension that are unique to women across their life spectrum. We performed a computerized search using PubMed, OVID, EMBASE, and Cochrane library databases between 1995 and 2023 that highlighted relevant clinical studies, challenges to the management of hypertension in women, and multidisciplinary approaches to hypertension control in women, including issues unique to racial and ethnic minority groups. Despite our current understanding of underlying mechanisms and strategies to manage hypertension in women, numerous challenges remain. Here, we discuss potential factors contributing to hypertension in women, differences related to effects of lifestyle modifications and drug therapy between men and women, the impact of sleep, and the importance of recognizing disparities in socioeconomic conditions and access to care. This review outlines several opportunities for future studies to fill gaps in knowledge to achieve optimal control of hypertension in women using a multidisciplinary approach, particularly related to sex-specific treatment approaches while considering socioeconomic conditions and life stages from premenopause through the transition to menopause.

Elevated isoleucine may be a protective factor for primary hypertension: A pooled causal effect study

Hypertension continues to pose a huge burden to global public health. Abnormal metabolism not only serves as a risk factor for hypertension but also acts as a driving force in its aggravation. However, there remains a lack of large-scale causal demonstration based on extensive samples. Our study aims to investigate the causal relationship between metabolism and primary hypertension (PH) using Mendelian randomization analysis. We used genome-wide association studies instrumental variables for Mendelian randomization association analysis integrating the diagnosis results of PH in 3 populations from East Asia, the Middle East, and Africa with serum metabolites and metabolite ratios. This allowed us to identify predictive metabolites and metabolic pathways for diagnosing or treating PH. Inverse-variance weighting was the main model for establishing causal associations. In addition horizontal pleiotropy test, linkage disequilibrium test, and sensitivity analysis were employed to test the explanatory power of instrumental variables. A total of 10,922 cases of PH and 8299 cases of metabolomics detection cohorts were included in the study. In East Asian, Middle Eastern, and African populations, we found 36, 57, and 40 known metabolites respectively strongly associated with PH (P < .05). Cross-section and meta-analysis of these strongly correlated metabolites across the 3 ethnic groups revealed 7 common metabolites. Notably, elevated isoleucine (odds ratio = 0.74, 95% confidence interval: 0.56-0.96) was demonstrated as a potential protective factor against PH across 3 ethnic groups. The metabolites associated with PH have certain polymorphisms in different populations. Isoleucine may be a promising biomarker for PH diagnosis or treatment, but more clinical validation is needed.

Prevalence and correlates of symptoms of depression, anxiety, and psychological distress among women of reproductive age with delayed conception in urban and peri-urban low to mid-socioeconomic neighborhoods of Delhi, India: A cross-sectional study

INTRODUCTION

One in six people of reproductive age experience infertility in their lifetime. Infertility can have significant impacts on mental health. Psychological distress is a broad term encompassing emotional suffering and mental health discomfort that can include symptoms of anxiety and depression but is not limited to these conditions. We investigated the prevalence of symptoms of depression, anxiety, and psychological distress and their associated risk factors among women of reproductive age with delayed conception.

METHODS

A total of 1530 women were recruited from community settings in Northern India. Quantitative data were collected using a 4-item Patient Health Questionnaire-4 (PHQ-4) which is an ultra-brief self-report questionnaire consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (generalized anxiety depression-2). Data were collected between July 2020 and August 2021. Descriptive analysis was conducted to summarise the characteristics and prevalence of symptoms of depression, anxiety, and psychological distress. Logistic regression was used to identify risk factors for psychological distress.

RESULTS

We obtained responses from all 1,530 women using these scales. Over half (54.31%) of participants had psychological distress, of whom 38.10% were experiencing mild distress, 10.59% moderate distress, and 5.62% severe distress. Additionally,16.07% of participants reported symptoms of anxiety and 20% reported symptoms of depression. Factors associated with psychological distress were: (i) a higher total number of children that women intended to have in their lifetime, (ii) longer duration of trying to get pregnant (> 18 months), (iii) continuous effort trying to achieve pregnancy, (iv) women's perception that conception is taking long, (v) social isolation, (vi) being emotionally or verbally abused by husband and family members, and (vii) having other co-morbidities such as hypertension, irregular menstrual cycles, irregular bleeding between regular cycles, abnormal vaginal discharge or pain during sex.

CONCLUSION

This study demonstrates the high mental health burden faced by women with delayed conception in low- to mid-socioeconomic neighbourhoods of North India including high levels of anxiety and depression. To better support individuals and couples achieve their reproductive goals, we advocate for the integration of psychosocial interventions to improve mental health outcomes and promote the well-being of those facing delays in achieving pregnancy. Specifically, addressing social isolation, fostering supportive networks, combating violence towards women, and incorporating fertility counselling and group-based psychosocial interventions within community and healthcare settings are needed to alleviate mental health symptoms among women who have difficulties in conceiving. However, the successful implementation of these recommendations may be challenged by the availability of the state's healthcare resources, necessitating tailored strategies with contextual adaptations.

Machine learning analysis of emerging risk factors for early-onset hypertension in the Tlalpan 2020 cohort

Introduction

Hypertension is a significant public health concern. Several relevant risk factors have been identified. However, since it is a complex condition with broad variability and strong dependence on environmental and lifestyle factors, current risk factors only account for a fraction of the observed prevalence. This study aims to investigate the emerging early-onset hypertension risk factors using a data-driven approach by implementing machine learning models within a well-established cohort in Mexico City, comprising initially 2,500 healthy adults aged 18 to 50 years.

Methods

Hypertensive individuals were newly diagnosed during 6,000 person-years, and normotensive individuals were those who, during the same time, remained without exceeding 140 mm Hg in systolic blood pressure and/or diastolic blood pressure of 90 mm Hg. Data on sociodemographic, lifestyle, anthropometric, clinical, and biochemical variables were collected through standardized questionnaires as well as clinical and laboratory assessments. Extreme Gradient Boosting (XGBoost), Logistic Regression (LG) and Support Vector Machines (SVM) were employed to evaluate the relationship between these factors and hypertension risk.

Results

The Random Forest (RF) Importance Percent was calculated to assess the structural relevance of each variable in the model, while Shapley Additive Explanations (SHAP) analysis quantified both the average impact and direction of each feature on individual predictions. Additionally, odds ratios were calculated to express the size and direction of influence for each variable, and a sex-stratified analysis was conducted to identify any gender-specific risk factors.

Discussion

This nested study provides evidence that sleep disorders, a sedentary lifestyle, consumption of high-fat foods, and energy drinks are potentially modifiable risk factors for hypertension in a Mexico City cohort of young and relatively healthy adults. These findings underscore the importance of addressing these factors in hypertension prevention and management strategies.

Closing the Gap: Digital Innovations to Address Hypertension Disparities

PURPOSE OF REVIEW

Significant inequities persist in hypertension detection and control, with minoritized populations disproportionately experiencing organ damage and premature death due to uncontrolled hypertension. Remote blood pressure monitoring combined with telehealth visits (RBPM) is proving to be an effective strategy for controlling hypertension. Yet there are challenges related to technology adoption, patient engagement and social determinants of health (SDoH), contributing to disparities in patient outcomes. This review summarizes the evidence to date for RBPM, focusing on the potential to advance health equity in blood pressure control and the existing levers for largescale implementation.

RECENT FINDINGS

Several studies demonstrate the promise of RBPM programs to address health disparities through: (1) the use of cellular-enabled blood pressure machines that do not require internet access or smart devices to connect readings into the medical record; (2) emphasis on home blood pressure monitoring to illuminate the daily factors that influence blood pressure control, thereby increasing patient empowerment; (3) adoption of standardized algorithms for hypertension management; and (4) integration of services to address SDoH. Multidisciplinary, non-physician care teams that include nurses, pharmacists, and community health workers are integral to this model. However, most studies have not embraced all aspects of RBPM, and implementation is challenging as current payment models do not support the digital components of RBPM or a diverse workforce of hypertension providers.

CONCLUSION

To address hypertension disparities, RBPM programs need to integrate digital technology that is accessible to all users as well as multidisciplinary care teams that attend to the medical and social needs of populations experiencing health inequities.

Cardiovascular comorbidities, mental health, and physical activity in persons with multiple sclerosis

This study examined the associations among cardiovascular comorbidities, symptoms of depression and anxiety, and physical activity in persons with multiple sclerosis. Participants with multiple sclerosis (N = 217) completed demographic, cardiovascular comorbidity, depression, and anxiety self-report measures, and wore an accelerometer for 7 days. We examined the bivariate, non-parametric correlations among the variables and conducted parametric, independent samples t-tests when examining the differences in variables based on cardiovascular comorbidity status. Bivariate correlation analysis indicated that there were statistically significant associations between anxiety scores, but not depression scores, and cardiovascular comorbidities. Physical activity, especially moderate-to-vigorous physical activity (MVPA), was correlated with cardiovascular comorbidities. There were small significant differences based on hyperlipidemia status in anxiety scores (p = 0.015, d = -0.42), MVPA (p < 0.001, d = 0.44), and steps/day (p < 0.001, d = 0.50), and based on hypertension status in anxiety scores (p = 0.010, d = -0.35), depression scores (p = 0.046, d = -0.26), MVPA (p = 0.003, d = 0.41), and steps/day (p < 0.001, d = 0.53). The findings indicate that there are significant associations among cardiovascular comorbidities, symptoms of depression and anxiety, and physical activity in persons with multiple sclerosis. Physical activity, specifically MVPA, may be a target for managing those outcomes in persons with multiple sclerosis.

Analysis of anxiety and depression status and their influencing factors in patients with diabetic retinopathy

BACKGROUND

Diabetic retinopathy (DR) is a common complication of diabetes and the leading cause of visual impairment and blindness. It has a serious impact on the mental and physical health of patients.

AIM

To evaluate the anxiety and depression status of patients with DR, we examined their influencing factors.

METHODS

Two hundred patients with DR admitted to the outpatient and inpatient departments of ophthalmology and endocrinology at our hospital were selected. A questionnaire was conducted to collect general patient information. Depression and anxiety were assessed using the Patient Health Questionnaire-9 and Seven-item Generalized Anxiety Disorder scale, respectively. The diabetes specific quality of life scale and Social Support Rating Scale were used to assess the quality of life of patients with DR and their social support, respectively. Logistic regression analysis was used to assess the correlations.

RESULTS

The prevalence of depression and anxiety were 26% (52/200) and 14% (28/200), respectively. Regression analysis revealed that social support was associated with depression [odds ratio (OR) = 0.912, 95% confidence interval (CI): 0.893-0.985] and anxiety (OR = 0.863, 95%CI: 0.672-0.994). Good quality of life (diabetes specific quality of life scale score < 40) was a protective factor against anxiety (OR = 0.738, 95%CI: 0.567-0.936) and depression (OR = 0.573, 95%CI: 0.4566-0.784). Visual impairment significantly increased the likelihood of depression (OR = 1.198, 95%CI: 1.143-1.324) and anxiety (OR = 1.746, 95%CI: 1.282-2.359). Additionally, prolonged diabetes duration and history of hypertension were significant risk factors for both conditions, along with a family history of diabetes.

CONCLUSION

Key factors influencing anxiety and depression in patients with DR include social support, quality of life, visual impairment, duration of diabetes, family history of diabetes, and history of hypertension.

The impact of COVID-19 on referrals among general practitioners and specialists in Shanghai, China

BACKGROUND

The COVID-19 pandemic has impacted patient's visits to general practitioners (GPs). However, it is unclear what the impact of COVID-19 has been on the interaction among the local primary care clinics, the GP Department within the hospital and specialists.

METHODS

The interaction among GPs referring to hospital-based specialists and specialists to local doctors was determined, comparing pre-pandemic 2019 and 2020 during the pandemic.

RESULTS

Reduced referrals from GPs to specialists were consistent with the reduction in specialist referrals back to the local doctors, which dropped by approximately 50% in 2020, particularly in the two most common chronic conditions (hypertension and diabetes mellitus).

DISCUSSION

Reduced referral of patients from local clinics to Tongren Hospital is probably due to the extensive online training provided to the local GPs to become more competent in handling local patients via telehealth. Our data provide some insight to assist in combatting the pandemic of COVID-19, offering objective evidence of the impact of COVID-19 on patient management by GPs.

Hypothalamic Regulation of Cardiorespiratory Functions: Insights into the Dorsomedial and Perifornical Pathways

The dorsomedial hypothalamus nucleus (DMH) plays a pivotal role in the orchestration of sympathetic nervous system activities. Through its projections to the brainstem and pontomedullary nuclei, it controls heart rate, contractility, blood pressure, and respiratory activity, such as timing and volumes. The DMH integrates inputs from higher brain centers and processes these signals in order to modulate autonomic outflow accordingly. It has been demonstrated to be of particular significance in the context of stress responses, where it orchestrates the physiological adaptations that are necessary for all adaptative responses. The perifornical region (PeF), which is closely associated with the DMH, also makes a contribution to autonomic regulation. The involvement of the PeF region in autonomic control is evidenced by its function in coordinating the autonomic and endocrine responses to stress, frequently in conjunction with the DMH. The DMH and the PeF do not function in an isolated manner; rather, they are components of a comprehensive hypothalamic network that integrates several autonomic responses. This neural network could serve as a target for developing therapeutic strategies in cardiovascular diseases.

Associations of Anxiety Symptoms With 6-Year Blood Pressure Changes and Incident Hypertension: Results From the Hispanic Community Health Study/Study of Latinos

BACKGROUND

Despite the high burden of anxiety and hypertension in Hispanic/Latino adults, little is known about their association in this population.

PURPOSE

To examine the associations of anxiety symptoms with 6-year changes in blood pressure (BP) and incident hypertension in Hispanic/Latino adults.

METHODS

We examined data from a probability sample of 10,881 Hispanic/Latino persons aged 18-74 who attended visits 1 (V1; 2008-2011) and 2 (V2; 2014-2017) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a prospective cohort study. Anxiety symptoms were assessed at V1 using the 10-item Spielberger Trait Anxiety Scale (M = 17.1; Range = 10-40) and dichotomized using a cut-point of 20, the highest quartile in this cohort. BP was measured at both visits using a standardized protocol.

RESULTS

Adults with elevated anxiety symptoms had a 1.02 mm Hg greater increase in systolic (p = .02) and a 0.75 mm Hg greater increase in diastolic BP (p = .02) over 6.1 years than those with lower symptoms, after adjusting for sociodemographic and clinical covariates. These associations differed by sex. Elevated anxiety was associated with a greater increase in systolic and diastolic BP in men only. Among persons without hypertension at V1 (N = 7,412), those with elevated anxiety symptoms at V1 had a 22% higher incidence of hypertension (p = .02) 6.1 years later.

CONCLUSIONS

Our findings underscore the importance of screening for and treating elevated anxiety symptoms to help prevent hypertension. Further research on the role of sex and underlying mechanisms is warranted.

Effectiveness of a Patient-Family Carer Partnership Intervention on Blood Pressure Control for People with Hypertension in Rural Communities: A Randomised Controlled Trial

Objectives

To examine the effectiveness of a patient-family (carer) partnership intervention on the BP control, self-care and self-efficacy for hypertensive people, and dyadic-relationship quality, depressive and anxiety symptoms, and health-related quality of life for the family dyads (hypertensive people and family carers) in rural communities of mainland China.

Design

A randomised controlled trial.

Methods

A total of 110 family dyads were randomly recruited from village clinics and randomly allocated to the intervention group (n = 55) or control group (n = 55). Family dyads in the control group received usual care. In addition to the usual care, family dyads in the intervention group received the individual-based, five-session patient-family (carer) partnership intervention. The primary outcomes included SBP, DBP, and the proportion of people with normal controlled BP. EuroQol five-dimensional-five-level (EQ-5D-5L) was adopted to evaluate participants' health-related quality of life. Data were collected at the baseline (T0), one-month (T1), and three-month postintervention (T2). Generalised estimating equation model was adopted to test the study hypotheses on all study outcomes.

Results

Compared with the control group, hypertensive people in the intervention group had a greater reduction in SBP by 10.10 mmHg and DBP by 4.66 mmHg and a larger proportion of people with normal BP at T2, as well as statistically significant improvements at T1 and T2 in dyadic relationship, self-care, antihypertensive drug-titration rate, anxiety symptoms, and health-related quality of life. The intervention also had statistically significant positive effects on family carer's dyadic relationship and health-related quality of life at T1 and T2.

Conclusion

The patient-family (carer) partnership intervention has the potential to improve hypertensive people's BP control and family dyad's dyadic-relationship quality and mental health at short-to-medium term follow-ups. Implications for the Profession and/or Patient Care. This study provided evidence and direction to support healthcare providers in developing and implementing patient-family (carer) partnership intervention for hypertension care in rural areas. This trial is registered with ChiCTR1900027087.

Association of mental health-related patient reported outcomes with blood pressure in adults and children with primary proteinuric glomerulopathies

INTRODUCTION

The prevalence of mental health disorders including anxiety and depression is increasing and is linked to hypertension in healthy individuals. However, the relationship of psychosocial patient-reported outcomes on blood pressure (BP) in primary proteinuric glomerulopathies is not well characterized. This study explored longitudinal relationships between psychosocial patient-reported outcomes and BP status among individuals with proteinuric glomerulopathies.

METHODS

An observational cohort study was performed using data from 745 adults and children enrolled in the Nephrotic Syndrome Study Network (NEPTUNE). General Estimating Equations for linear regression and binary logistic analysis for odds ratios were performed to analyze relationships between the exposures, longitudinal Patient-Reported Outcome Measurement Information System (PROMIS) measures and BP and hypertension status as outcomes.

RESULTS

In adults, more anxiety was longitudinally associated with higher systolic and hypertensive BP. In children, fatigue was longitudinally associated with increased odds of hypertensive BP regardless of the PROMIS report method. More stress, anxiety, and depression were longitudinally associated with higher systolic BP index, higher diastolic BP index, and increased odds of hypertensive BP index in children with parent-proxy patient-reported outcomes.

DISCUSSION/CONCLUSION

Chronically poor psychosocial patient-reported outcomes may be significantly associated with higher BP and hypertension in adults and children with primary proteinuric glomerulopathies. This interaction appears strong in children but should be interpreted with caution, as multiple confounders related to glomerular disease may influence both mental health and BP independently. That said, access to mental health resources may help control BP, and proper disease and BP management may improve overall mental health.

The role of subjective, interpersonal, and structural social isolation in 12-month and lifetime anxiety disorders

BACKGROUND

Anxiety disorders are among the most prevalent psychiatric conditions worldwide, and the incidence of anxiety disorders among adults in the U.S. have increased over the last decade. Anxiety disorders can have debilitating effects on multiple areas of functioning and quality of life. Recently, social isolation has emerged as an important public health problem associated with worse health and well-being outcomes. Research on the connection between social isolation and mental health has found that multiple dimensions of social isolation may negatively impact mental health, but few inquiries have focused on the association between social isolation and anxiety. This study examined the relationships between multiple dimensions of social isolation and anxiety disorders in a nationally representative sample of adults aged 18 and older.

METHODS

The sample includes 6082 individuals from the National Survey of American Life. This study examined whether three different dimensions of social isolation-subjective, interpersonal, and structural-were associated with 12-month and lifetime anxiety disorders (any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were used to test the associations between the three social isolation variables and the anxiety outcomes.

RESULTS

This study found that of the three dimensions of social isolation, subjective isolation was most consistently related to both lifetime and 12-month anxiety disorders. Those who were subjectively isolated had increased odds of meeting criteria for any anxiety disorder, PTSD, GAD, PD, and AG over the past 12 months and throughout their lifetimes. Structural isolation was negatively associated with lifetime and 12-month AG.

CONCLUSIONS

Public health approaches should include mental health and primary care providers and need to target social isolation, especially subjective isolation, which may be key in preventing anxiety disorders and the worsening of anxiety disorders. Future public health research is needed on how and in what ways the differing dimensions of social isolation impact mental health.

The impact of comorbidity on the diagnosis delay, treatment options and prognosis for advanced oral cancer: A retrospective result of the POROMS database

This study aimed to reveal the underlying mechanisms linking advanced oral squamous cell carcinoma (OSCC) with its comorbidities. Data extracted from the POROMS database included 448 advanced OSCC patients in stage III or IV (AJCC 8th) with primary tumors between August 2015 and August 2021. Time to diagnosis delay increased from 4.5, 5.3-6.5 months when the Adult Comorbidity Evaluation-27 (ACE-27) worsened from none, mild (RR: 1.155, 1.043-1.279; P = 0.006) to moderate-severe (RR: 1.431, 1.251-1.636; P < 0.001). With the number of comorbidities increased from 0, 1-2 (RR: 1.188, 1.078-1.310; P = 0.001) to 3 (RR: 1.563, 1.296-1.885; P < 0.001), the time to diagnosis delay increased from 4.5, 5.4-7.1 months. As the level and number of comorbidities increased, the likelihood of treatment completion gradually declined, especially in those older than 65 years (P = 0.003). The presence of comorbidity was an independent prognostic factor for disease-free survival (HR: 1.431, 1.022-2.005; P = 0.037). Comorbidities may lead to poorer prognosis by directly causing delays in diagnosis, limiting treatment options, and increasing the risk of death in advanced OSCC patients.

Anti-hypertensive and composition as well as pharmacokinetics and tissues distribution of active ingredients from Alpinia zerumbet

Alpinia zerumbet is a food flavor additive and a traditional medicine herb around the world. Several studies have reported that A. zerumbet has excellent effects on a variety of cardiovascular diseases, but its potential hypertensive applications, and pharmacokinetic features of main active substances have not been fully investigated. The mechanism of anti-hypertension with ethyl acetate extracts of A. zerumbet fruits (AZEAE) was evaluated by L-NNA-induced hypertensive rats and L-NAME-injured human umbilical vein endothelial cells (HUVECs). Blood pressure, echocardiographic cardiac index and H&E staining were used to preliminary evaluate the antihypertensive effect of AZEAE, the levels of TNF-α, IL-6, and IL-1β were evaluated by ELISA, and the proteins expression of IL-1β, IL-18, AGTR1, VCAM, iNOS, EDN1 and eNOS were also evaluated. In addition, isolation, identification, and activity screening of bioactive compounds were carried ou. Next, pharmacokinetics and tissues distribution of dihydro-5,6-dehydrokavain (DDK) in vivo were measured, and preliminary absorption mechanism was conducted with Caco-2 cell monolayers. AZEAE remarkably enhanced the state of hypertensive rats. Twelve compounds were isolated and identified, and five compounds were isolated from this plant for the first time. The isolated compounds also exhibited good resistance against injury of HUVECs. Moreover, pharmacokinetics and Caco-2 cell monolayers demonstrated AZEAE had better absorption capacity than DDK, and DDK exhibited differences in tissues distribution and gender difference. This study was the first to assess the potential hypertensive applications of A. zerumbet in vivo and vitro, and the first direct and concise study of the in vivo behavior of DDK and AZEAE.

Unveiling the Nexus: Depressive Symptoms and Medication Adherence in Hypertensive Patients' Self-care: A Systematic Review

Background

Hypertension, a significant public health concern, is frequently linked to emotional disorders like depression. Research shows a reciprocal link between depression and hypertension, potentially influencing patients' adherence to self-care routines.

Objective

This systematic review aimed to examine the association between depressive symptoms and aspects of self-care, with a focus on medication adherence in individuals diagnosed with hypertension.

Methods

Following PRISMA guidelines, a systematic review was conducted by searching PubMed, PsycINFO and Scopus until March 17, 2023. The included studies involved quantitative primary research conducted in English, focusing on adults (≥18 years) diagnosed with hypertension and experiencing depressive symptoms. Observational studies were assessed using the Newcastle-Ottawa Scale, and randomized controlled trials were evaluated using the revised Cochrane Risk of Bias Tool (RoB 2.0). Due to the great diversity of these studies, a narrative synthesis of the results was undertaken. Results: A total of 18 studies involving 6,131 people with hypertension, that met our eligibility criteria were ultimately included. The reported rates of depressive symptoms ranged from 4% to 43%. Of these studies, nine reported a statistically significant association, showcasing an adverse impact of depressive symptoms on medication adherence. The remaining nine did not confirm the above.

Conclusion

This systematic review highlights the diverse body of research exploring depressive symptoms and medication adherence among individuals with hypertension. The review suggests a need for increased attention to self-care practices, particularly in relation to adherence to antihypertensive medication. However, it recommends the conduction of more robust longitudinal studies to comprehensively explore this relationship.

Anxiety symptoms and associated factors among school students after 2 years of the COVID-19 pandemic: a cross-sectional study in Zhejiang Province, China

OBJECTIVES

To ascertain the prevalence and associated factors of anxiety symptoms among middle and high school students in Zhejiang after 2 years of the COVID-19 pandemic.

DESIGN

A school-based cross-sectional study.

SETTING

30 counties/districts in Zhejiang Province, China.

PARTICIPANTS

27 019 students attending middle and high schools.

OUTCOME MEASURES

Anxiety symptoms were assessed using the Generalised Anxiety Disorder 7-item scale (GAD-7). A total score of 10 or more is considered indicative of anxiety symptoms.

RESULTS

The overall prevalence (95% CI) of anxiety symptoms was 14.2% (13.4 to 15.0), higher among girls (18.6%, 95% CI: 17.5 to 19.7) than boys (10.2%, 95% CI: 9.5 to 10.9) (p<0.001), higher among rural students (15.1%, 95% CI: 14.1 to 16.2) than urban students (12.5%, 95% CI: 11.6 to 13.4) (p<0.001). Older age (14-15 years, OR=1.25, 95% CI: 1.09 to 1.44; ≥16 years, OR=1.32, 95% CI: 1.07 to 1.63), being girls (OR=1.76, 95% CI: 1.58 to 1.96), living in rural areas (OR=1.14, 95%CI: 1.01 to 1.29), poor academic performance (OR=1.20, 95% CI: 1.03 to 1.41), alcohol drinking (OR=1.15, 95% CI: 1.01 to 1.30), inadequate fruits (OR=1.31, 95% CI: 1.19 to 1.45) and vegetables intake (OR=1.32, 95% CI: 1.10 to 1.57), insomnia (sometimes, OR=2.14, 95% CI: 1.93 to 2.38; often/always, OR=4.73, 95% CI: 4.03 to 5.56), loneliness (sometimes, OR=2.97, 95%CI: 2.59 to 3.41; often/always, OR=8.35, 95% CI: 7.20 to 9.69), sadness (OR=2.51, 95% CI: 2.25 to 2.79) and physical fight (OR=1.29, 95% CI: 1.13 to 1.48) were positively associated with anxiety symptoms, while studying at vocational high school (OR=0.61, 95% CI: 0.49 to 0.75), coming from family with middle income (OR=0.76, 95% CI: 0.64 to 0.89), being physically active 3-7 days weekly (OR=0.85, 95% CI: 0.75 to 0.95) were negatively associated with anxiety symptoms.

CONCLUSION

Anxiety symptoms prevailed among middle and high school students in China. A variety of factors, containing sociodemographic factors, lifestyle behaviours, mental health, academic performance and physical fight should be taken in consideration in addressing prevention and intervention of anxiety symptoms.

Reduction of anxiety symptoms among women within a collaborative care model and women's health settings

AIM

The purpose of this study is to focus on changes in anxiety symptoms among women treated in women's health practices and under a collaborative care model.

BACKGROUND

Research on collaborative care has largely focused on improving depressive and anxiety symptoms among adults in primary care settings. The applicability of collaborative care in other healthcare settings is underreported with limited research investigating if collaborative care has advantages in subpopulations treated in both traditional primary care settings and other healthcare settings, such as women's health practices.

METHODS

This study, completed through secondary data analysis of the electronic record of N = 219 women across three women's healthcare centers, evaluated if instituting a collaborative care model is associated with reduced anxiety symptoms and which factors (eg, primary diagnosis, duration of care, and use of psychotropic medications) are associated with anxiety outcomes. Anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7) at entry into and at termination from collaborative care services.

RESULTS

Overall, there was a significant reduction in average anxiety scores from baseline to termination of collaborative care (t(218) = 12.41, P < 0.001). There was a main effect for the duration of time receiving collaborative care services on anxiety score reduction (β = -0.28, SE = 0.06, P < 0.001) with a significant reduction in anxiety symptoms at the 90-day mark (t(218) = 10.58, P < 0.001). Therefore, collaborative care can be useful in women's health practices in reducing anxiety symptoms over a 90-day time period.

Black American women's attitudes toward seeking mental health services and use of mobile technology to support the management of anxiety

Objectives

This study aimed to understand Black American women's attitudes toward seeking mental health services and using mobile technology to receive support for managing anxiety.

Methods

A self-administered web-based questionnaire was launched in October 2019 and closed in January 2020. Women who identified as Black/African American were eligible to participate. The survey consisted of approximately 70 questions and covered topics such as, attitudes toward seeking professional psychological help, acceptability of using a mobile phone to receive mental health care, and screening for anxiety.

Results

The findings of the study (N = 395) showed that younger Black women were more likely to have greater severity of anxiety than their older counterparts. Respondents were most comfortable with the use of a voice call or video call to communicate with a professional to receive support to manage anxiety in comparison to text messaging or mobile app. Younger age, higher income, and greater scores for psychological openness and help-seeking propensity increased odds of indicating agreement with using mobile technology to communicate with a professional. Black women in the Southern region of the United States had twice the odds of agreeing to the use of mobile apps than women in the Midwest and Northeast regions.

Discussion

Black American women, in general, have favorable views toward the use of mobile technology to receive support to manage anxiety.

Conclusion

Preferences and cultural appropriateness of resources should be assessed on an individual basis to increase likelihood of adoption and engagement with digital mental health interventions for management of anxiety.

Evaluation of retinal thickness measured by optical coherence tomography in patients with generalized anxiety disorder

PURPOSE

To compare the peripapillary retinal nerve fiber layer thickness, macular thickness, ganglion cell layer thickness, and inner plexiform layer thickness determined by Optic Coherence Tomography in the patient group diagnosed with a generalized anxiety disorder who did not receive any psychiatric medication with the healthy control group.

METHODS

Forty newly diagnosed, drug-free Generalized Anxiety Disorder patients and 43 healthy age- and gender-matched control subjects were included in the study. Macular thickness, ganglion cell layer thickness, inner plexiform layer thickness, and peripapillary retinal nerve fiber layer thickness were measured using optical coherence tomography. Structured Clinical Interviews and a State-Trait Anxiety Scale were applied to both groups.

RESULTS

Gender distributions (P = 0.965) and mean ages were similar between the groups (P = 0.340). Retinal nerve fiber layer thickness measurements were not significantly different between the groups. We observed statistically significant thinning in the inner superior, inner nasal, inner temporal, inner inferior, and outer inferior quadrants of the macula in the patient group compared to the control group (P = 0.046, P = 0.046, P = 0.020, P = 0.007, P = 0.014). We found thinning at the Ganglion cell layer in the inner inferior and outer temporal quadrants (Respectively P = 0.018, P = 0.049), inner plexiform layer in the inner nasal, inner temporal, and inner inferior quadrants (Respectively P = 0.046, P = 0.044, P = 0.011) compared to the control group.

CONCLUSIONS

This is the first study to reveal thinning in the macula, ganglion cell layer, and inner plexiform layer in newly diagnosed, drug-free Generalized Anxiety Disorder patients compared to the control group.

What is resistant arterial hypertension?

PURPOSE

The current review is to describe the definition and prevalence of resistant arterial hypertension (RAH), the difference between refractory hypertension, patient characteristics and major risk factors for RAH, how RAH is diagnosed, prognosis and outcomes for patients.

MATERIALS AND METHODS

According to the WHO, approximately 1.28 billion adults aged 30-79 worldwide have arterial hypertension, and over 80% of them do not have blood pressure (BP) under control. RAH is defined as above-goal elevated BP despite the concurrent use of 3 or more classes of antihypertensive drugs, commonly including a long-acting calcium channel blocker, an inhibitor of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a thiazide diuretic administered at maximum or maximally tolerated doses and at appropriate dosing frequency. RAH occurs in nearly 1 of 6 hypertensive patients. It often remains unrecognised mainly because patients are not prescribed ≥3 drugs at maximal doses despite uncontrolled BP.

CONCLUSION

RAH distinctly increases the risk of developing coronary artery disease, heart failure, stroke and chronic kidney disease and confers higher rates of major adverse cardiovascular events as well as increased all-cause mortality. Timely diagnosis and treatment of RAH may mitigate the associated risks and improve short and long-term prognosis.

Associations between depressive, anxiety, stress symptoms and elevated blood pressure: Findings from the CHCN-BTH cohort study and a two-sample Mendelian randomization analysis

BACKGROUND

We aimed to determine whether depressive, anxiety, stress symptoms were associated with the risk of elevated blood pressure by performing longitudinal cohort and Mendelian Randomization (MR) analyses.

METHODS

We used data from the Cohort Study on Chronic Disease of Community Natural Population in the Beijing-Tianjin-Hebei region (CHCN-BTH) from 2017 to 2021. The Depression-Anxiety-Stress Scale was used to evaluate the depressive, anxiety, stress symptoms. The longitudinal associations between depressive, anxiety, stress symptoms and elevated blood pressure were estimated using Cox proportional regression models. Two-sample MR analysis was performed using the Inverse-variance weighted (IVW), weighted median, and MR-Egger to explore the causal relationships between depressive, anxiety, stress symptoms and elevated blood pressure.

RESULTS

In total, 5624 participants were included. The risk of SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was significantly higher in participants with baseline anxiety symptoms (HR = 1.48, 95 % CI: 1.03 to 2.12, P = 0.033; HR = 1.56, 95 % CI: 1.05 to 2.32, P = 0.028), especially in men and individuals with higher educational levels, independent of baseline depression and anxiety at the two-year follow-up. The two-sample MR analysis showed positive associations between depressive, anxiety, stress symptoms and elevated blood pressure.

LIMITATION

Self-reported mental health symptoms, relatively shorter follow-up duration and the European-derived genome-wide association study data for MR analysis.

CONCLUSIONS

Anxiety symptoms were positively associated with elevated blood pressures in the longitudinal analysis independent of depression, stress, and other confounders. The results were verified in MR analysis, providing evidence for causal effects of anxiety symptoms on the risk of elevated blood pressure.

Global Prevalence of Anxiety in Adult Cardiology Outpatients: A Systematic Review and Meta-analysis

Anxiety and anxiety disorders are associated with adverse cardiovascular outcomes, and reduced quality of life. Despite this, no comprehensive study on the global prevalence of anxiety symptoms and disorders among adult cardiology outpatients exists. This systematic review and meta-analysis aims to provide cardiologists with a precise estimate of the prevalence of anxiety in their outpatient clinics. PubMed, Embase, Cochrane and PsycINFO databases and Google Scholar were searched from database inception to January 23, 2023. Data characteristics were extracted independently by 2 investigators. Ninety-three studies, n = 36,687 participants across 31 countries, were included. Global prevalence of anxiety symptoms/disorders was 28.9% (95%CI 25.7-32.4; 8927/36, 687; I2 = 97.33; n = 93). The highest rates were found in patients presenting with hypertension, 43.6%. Subgroup analyses revealed higher prevalence estimates when using self-report screening compared to gold-standard diagnostic interview. When using diagnostic interview, the highest rates were reported in outpatients with undifferentiated chest pain/palpitations, 19·0%. Panic disorder was the most frequent diagnosis 15.3%, and rates were significantly higher in patients with undifferentiated chest pain/palpitations compared to ischemic heart disease. Higher rates of anxiety were found in studies of outpatients from developing countries, and female outpatients tended to have higher rates compared to males. Anxiety occurred frequently among cardiology outpatients and at a higher rate than estimated in the general population. Given the impact anxiety has on patient outcomes, it is important that effective identification and management strategies be developed to support cardiologists in identifying and treating these conditions in their clinics.

The effects of cannabidiol on worry and anxiety among high trait worriers: a double-blind, randomized placebo controlled trial

RATIONALE

Evidence suggests cannabidiol (CBD) displays broad therapeutic potential in the context of anxiety; however, no study has examined the effects of CBD on worry, a defining, cognitive feature of anxiety. Additionally, no study has examined the effects of an acute, single dose of CBD compared to repeated CBD administration.

OBJECTIVES

Within a sample of 63 individuals with elevated trait worry, the current study aimed to assess the effects of an empirically-derived high dose of CBD (i.e., 300mg) compared to a commercially-derived dose of CBD (i.e., 50mg) versus placebo on worry severity and anxiety symptoms after an acute dose and after a 2-week administration period.

RESULTS

Results indicated no effect of acute CBD dosing on worry severity or anxiety symptoms. Repeated CBD administration similarly did not impact worry severity; however, 300mg of CBD reduced anxiety symptoms across the 2-week administration period compared to placebo.

CONCLUSIONS

Taken together, these findings suggest 300mg of oral CBD does not attenuate cognitive symptoms of anxiety (i.e., worry), following both acute and repeated administration. Some evidence for repeated administration of 300mg on physical symptoms of anxiety was obtained. Findings from the current study suggest CBD's modest anxiolytic effects may be specific to the physical aspects of anxious arousal.

Evolution of Anxiety Disorder Prevalence and Associated Factors in First Responders in Both the Medium and Long Terms after the January 2015 Terrorist Attacks in France

First responders intervening in crisis situations are likely to subsequently develop mental disorders. We aimed to identify factors associated with anxiety disorders after a terrorist attack in both the medium and long terms. We used data collected on 180 first responders (medical/psychological health professionals and emergency rescue teams) interviewed face to face at 6-10 months (medium term) and 18-22 months (long term) after the January 2015 terrorist attacks in France. Anxiety disorders were measured using the Mini-International Neuropsychiatric Interview V6 and several other variables including terror exposure (comprising perceived level of exposure and real exposure level), sociodemographic characteristics, social support, mental health history, and access to psychological support resources. We developed a structural equation model to examine the interactions between these different factors. Postattack anxiety disorder prevalence in the medium and long terms was 16% and 14%, respectively. The main associated factors in the medium term were barriers to social support, perceived level of exposure, and a lack of psychological support resources. In the long term, the presence of anxiety disorders in the medium term and barriers to social support were directly associated with having anxiety disorders, while reexposure was indirectly associated. Barriers to social support played a crucial role in the prevalence of anxiety disorders in first responders following this traumatic event, both in the medium and long terms. Promoting stronger social cohesion and providing more psychological support resources following a disaster could help prevent anxiety disorders in this population.

Research on the psychological status of medical staff during the COVID-19 epidemic in China: A longitudinal study

An online questionnaire, including the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), was used to assess the psychological status of medical staff in Wuhan during the COVID-19 epidemic. Lasso-Logistic regression analysis was performed to analyze the risk factors of abnormal psychological status (anxiety or depression). 36.6% of the study subjects experienced anxiety, and 41.5% experienced depression. Female (OR [odds ratio] = 7.22, 95% CI [confidence interval]: 0.58-89.33), basic diseases (OR = 17.95, 95% CI: 1.59-202.49), suspected exposure history (OR = 9.63, 95% CI: 1.40-66.29), smoking (OR = 6.07, 95% CI: 0.38-96.78) were risk factors for anxiety. Female (OR = 5.00, 95% CI: 0.45-55.91), basic diseases (OR = 37.19, 95% CI: 2.70-512.73), suspected exposure history (OR = 5.10, 95% CI: 0.78-33.10), drinking wine (OR = 6.27, 95% CI: 0.38-103.85) were risk factors for depression. The results of the re-sampling evaluation after 2 years showed that some medical staff still showed anxiety (42.4%) and depression (27.3%), and the proportion of females was higher. Early intervention should be carried out, and short-term and long-term intervention plans should be formulated.

A Study of Brain Function Characteristics of Service Members at High Risk for Accidents in the Military

Military accidents are often associated with stress and depressive psychological conditions among soldiers, and they often fail to adapt to military life. Therefore, this study analyzes whether there are differences in EEG and pulse wave indices between general soldiers and three groups of soldiers who have not adapted to military life and are at risk of accidents. Data collection was carried out using a questionnaire and a device that can measure EEG and pulse waves, and data analysis was performed using SPSS. The results showed that the concentration level and brain activity indices were higher in the general soldiers and the soldiers in the first stage of accident risk. The body stress index was higher for each stage of accident risk, and the physical vitality index was higher for general soldiers. Therefore, it can be seen that soldiers who have not adapted to military life and are at risk of accidents have somewhat lower concentration and brain activity than general soldiers, and have symptoms of stress and lethargy. The results of this study will contribute to reducing human accidents through EEG and pulse wave measurements not only in the military but also in occupations with a high risk of accidents such as construction.

Factors influencing postoperative anxiety and depression following Iodine-131 treatment in patients with differentiated thyroid cancer: A cross-sectional study

BACKGROUND

Differentiated thyroid cancer (DTC) often seriously impacts patients’ lives. Radionuclide Iodine-131 (¹³¹I) is widely used in treating patients with DTC. However, most patients know little about radionuclide therapy, and the treatment needs to be performed in a special isolation ward, which can cause anxiety and depression.

AIM

To explore anxiety and depression status and their influencing factors after ¹³¹I treatment in patients with DTC.

METHODS

A questionnaire survey was conducted among postoperative patients with DTC who received ¹³¹I treatment at our hospital from June 2020 to December 2022. General patient data were collected using a self-administered demographic characteristics questionnaire. The self-rating depression scale and self-rating anxiety scale were used to determine whether patients were worried about their symptoms and the degree of anxiety and depression. The patients were cate-gorized into anxiety, non-anxiety, depression, and non-depression groups. Single-variable and multiple-variable analyses were used to determine the risk factors for anxiety and depression in patients with thyroid cancer after surgery.

RESULTS

A total of 144 patients were included in this study. The baseline mean score of self-rating anxiety and depression scales were 50.06 ± 16.10 and 50.96 ± 16.55, respectively. Notably, 48.62% (70/144) had anxiety and 47.22% (68/144) of the patients had depression. Sex, age, education level, marital status, household income, underlying diseases, and medication compliance significantly differed among groups (P < 0.05). Furthermore, multivariate logistic regression analysis showed that education level, per capita monthly household income, and medication compliance level affected anxiety (P = 0.015, 0.001, and 0.001 respectively. Patient’s sex, marital status, and underlying diseases affected depression (P = 0.007, 0.001, and 0.009, respectively).

CONCLUSION

Nursing interventions aiming at reducing the risk of anxiety and depression should target unmarried female patients with low education level, low family income, underlying diseases, and poor adherence to medications.

Generalization of contextual fear is sex-specifically affected by high salt intake

A hallmark symptom of many anxiety disorders, and multiple neuropsychiatric disorders more broadly, is generalization of fearful responses to non-fearful stimuli. Anxiety disorders are often comorbid with cardiovascular diseases. One established, and modifiable, risk factor for cardiovascular diseases is salt intake. Yet, investigations into how excess salt consumption affects anxiety-relevant behaviors remains little explored. Moreover, no studies have yet assessed how high salt intake influences generalization of fear. Here, we used adult C57BL/6J mice of both sexes to evaluate the influence of two or six weeks of high salt consumption (4.0% NaCl), compared to controls (0.4% NaCl), on contextual fear acquisition, expression, and generalization. Further, we measured osmotic and physiological stress by quantifying serum osmolality and corticosterone levels, respectively. Consuming excess salt did not influence contextual fear acquisition nor discrimination between the context used for training and a novel, neutral context when training occurred 48 prior to testing. However, when a four week delay between training and testing was employed to induce natural fear generalization processes, we found that high salt intake selectively increases contextual fear generalization in females, but the same diet reduces contextual fear generalization in males. These sex-specific effects were independent of any changes in serum osmolality nor corticosterone levels, suggesting the behavioral shifts are a consequence of more subtle, neurophysiologic changes. This is the first evidence of salt consumption influencing contextual fear generalization, and adds information about sex-specific effects of salt that are largely missing from current literature.

General Anxiety Disorder and Primary Hypertension: Is There a Link?

Chronic forms of morbidity, including mental disorders and hypertension, play a dominant role in determining a disease load in the developing world. This article investigates the associations between the diagnoses of primary hypertension and generalized anxiety disorder (GAD) and the severity of GAD in individuals with primary hypertension. The association of GAD and age, sex, marriage, education level, income, chronic medical conditions, family history of mental disorders, adverse life events, and hypertension was assessed in 470 patients with the diagnosis of primary hypertension. Data analysis was performed with IBM SPSS Statistics software version 16. A significant relationship was found between the prevalence of GAD and the following variables: history of mental disorders ( p < 0.0001), chronic medical conditions ( p < 0.0001), and adverse life events ( p < 0.0001). The mean anxiety score was higher among patients with uncontrolled blood pressure, and a significant relationship was observed between the prevalence of GAD and blood pressure ( p < 0.0001). Because of the significant association between GAD and primary hypertension, it is recommended that anxiety disorders be considered in patients in whom primary hypertension is not controlled easily. This may lead to more proper control of hypertension while taking fewer antihypertensive medications.

Neurogenic Background for Emotional Stress-Associated Hypertension

PURPOSE OF REVIEW

The response to natural stressors involves both cardiac stimulation and vascular changes, primarily triggered by increases in sympathetic activity. These effects lead to immediate flow redistribution that provides metabolic support to priority target organs combined with other key physiological responses and cognitive strategies, against stressor challenges. This extremely well-orchestrated response that was developed over millions of years of evolution is presently being challenged, over a short period of time. In this short review, we discuss the neurogenic background for the origin of emotional stress-induced hypertension, focusing on sympathetic pathways from related findings in humans and animals.

RECENT FINDINGS

The urban environment offers a variety of psychological stressors. Real or anticipatory, emotional stressors may increase baseline sympathetic activity. From routine day-to-day traffic stress to job-related anxiety, chronic or abnormal increases in sympathetic activity caused by emotional stressors can lead to cardiovascular events, including cardiac arrhythmias, increases in blood pressure and even sudden death. Among the various alterations proposed, chronic stress could modify neuroglial circuits or compromise antioxidant systems that may alter the responsiveness of neurons to stressful stimuli. These phenomena lead to increases in sympathetic activity, hypertension and consequent cardiovascular diseases. The link between anxiety, emotional stress, and hypertension may result from an altered neuronal firing rate in central pathways controlling sympathetic activity. The participation of neuroglial and oxidative mechanisms in altered neuronal function is primarily involved in enhanced sympathetic outflow. The significance of the insular cortex-dorsomedial hypothalamic pathway in the evolution of enhanced overall sympathetic outflow is discussed.

Relationship between psychological distress, health behaviours and future reports of hypertension among adults in East Zimbabwe: a cohort study

INTRODUCTION

Extensive cross-sectional evidence has demonstrated an association between psychological distress (PD) and hypertension. However, evidence on the temporal relationship is limited, especially in low-income and middle-income countries. The role of health risk behaviours including smoking and alcohol consumption in this relationship is also largely unknown. The aim of this study was to investigate the association between PD and later development of hypertension, and how this association may have been influenced by health risk behaviours, among adults in east Zimbabwe.

METHODS

The analysis included 742 adults (aged 15-54 years) recruited by the Manicaland general population cohort study, who did not have hypertension at baseline in 2012-2013, and who were followed until 2018-2019. In 2012-2013, PD was measured using the Shona Symptom Questionnaire, a screening tool validated for use in Shona-speaking countries including Zimbabwe (cut-off point: 7). Smoking, alcohol consumption and use of drugs (health risk behaviours) were also self-reported. In 2018-2019, participants reported if they had diagnosed with hypertension by a doctor or nurse. Logistic regression was used to assess the association between PD and hypertension.

RESULTS

In 2012, 10.4% of the participants had PD. The odds of new reports of hypertension were 2.04 times greater (95% CI 1.16 to 3.59) among those with PD at baseline, after adjusting for sociodemographic and health risk behaviour variables. Female gender (adjusted odds ratio, AOR 6.89, 95% CI 2.71 to 17.53), older age (AOR 2.67, 95% CI 1.63 to 4.42), and greater wealth (AOR 2.10, 95% CI 1.04 to 4.24 more wealthy, 2.88, 95% CI 1.24 to 6.67 most wealthy) were significant risk factors for hypertension. The AOR for the relationship between PD and hypertension did not differ substantially between models with and without health risk behaviours.

CONCLUSION

PD was associated with an increased risk of later reports of hypertension in the Manicaland cohort. Integrating mental health and hypertension services within primary healthcare may reduce the dual burden of these non-communicable diseases.

Impacts of Anxiety and Depression on Clinical Hypertension in Low-Income US Adults

INTRODUCTION

Depression and anxiety are common leading causes of disability and are associated with systemic effects including cardiovascular comorbidities. Low-income populations may experience higher frequencies of depressive or anxiety-related symptoms, and be at greater risk for developing hypertension.

AIM

We performed a cross-sectional study of low-income participants who completed hypertension and disability questionnaires as part of the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES) to identify associations between depressive/anxiety-related symptoms and hypertension status.

METHODS

Multivariable logistic regressions were performed to identify whether (1) frequency of depressive symptoms, (2) frequency of anxiety-related symptoms, (3) self-reported depression medication use, or (4) self-reported anxiety medication use predicted previous hypertension diagnosis.

RESULTS

A total of 74,285,160 individuals were represented in our cohort. Participants that reported taking depression (OR 2.72; 95% CI 1.41-5.24; P = 0.009) and anxiety (OR 2.50; 95% CI 1.42-4.41; P = 0.006) medications had greater odds of hypertension. Individuals with depressive feelings daily, monthly, and few times per year were more likely to have hypertension. Respondents with daily (OR 2.28; 95% CI 1.22-4.24; P = 0.021) and weekly (OR 1.88; 95% CI 1.05-3.38; P = 0.040) anxiety symptoms were more likely to have hypertension.

CONCLUSIONS

Low-income adults in the United States with symptoms of anxiety or depression have higher likelihood of hypertension than those with no symptoms. Respondents who indicated taking medication for anxiety disorders or depression were more likely to have been diagnosed with hypertension.

Comorbidity of Anxiety and Hypertension: Common Risk Factors and Potential Mechanisms

Anxiety is more common in patients with hypertension, and these two conditions frequently coexist. Recently, more emphasis has been placed on determining etiology in patients with comorbid hypertension and anxiety. This review focuses on the common risk factors and potential mechanisms of comorbid hypertension and anxiety. Firstly, we analyze the common risk factors of comorbid hypertension and anxiety including age, smoking, alcohol abuse, obesity, lead, and traffic noise. The specific mechanisms underlying hypertension and anxiety were subsequently discussed, including interleukin (IL)-6 (IL-6), IL-17, reactive oxygen species (ROS), and gut dysbiosis. Increased IL-6, IL-17, and ROS accelerate the development of hypertension and anxiety. Gut dysbiosis leads to hypertension and anxiety by reducing short-chain fatty acids, vitamin D, and 5-hydroxytryptamine (5-HT), and increasing trimethylamine N-oxide (TAMO) and MYC. These shared risk factors and potential mechanisms may provide an effective strategy for treating and preventing hypertension and comorbid anxiety.

Analysis of the prevalence and influencing factors of anxiety and depression in the Chinese population: A cross-sectional survey

To explore the prevalence and influencing factors of anxiety and depression symptoms among Chinese people in 2021. Investigation teams were recruited in 120 cities across the country. Based on the data from "the Seventh National Population Census in 2021″, quota sampling was conducted on the residents of these cities to obtain samples that conformed to population characteristics. Next, baseline information on research objects was collected, and the questionnaire survey was conducted through the online questionnaire Wenjuanxing platform. The Patient Health Questionnaire-9 (PHQ-9) rating scale was used to evaluate the mental state of the subjects. The correlation between baseline information and different PHQ-9 risk intervals was analyzed using the Chi-square test and Logit model. The impact of relevant risk factors on PHQ-9 scores was analyzed using the decision tree. The Chi-square test results revealed that place of residence (p = 0.438) and obesity (p = 0.443) was not significantly correlated with PHQ-9 risk intervals. According to Logit model analysis, age (p = 0.001, 95%CI 0.84-0.96), marital status (p < 0.001, 95%CI 0.71-0.89), drinking (p < 0.001, 95%CI 1.07-1.18), diabetes or hypertension (p = 0.001, 95%CI 1.11-1.47), health care (p < 0.001, 95%CI 0.53-0.66), economic welfare (p = 0.022, 95%CI 0.85-0.99), COVID-19 vaccine (p < 0.001, 95%CI 1.28-1.72), and HPV vaccine (p < 0.001, 95%CI 0.46-0.57) were potential influencing factors of PHQ-9 risk intervals. Decision tree analysis results showed that the grouping strategy in the PHQ-9 two-side groups had a better classification effect on the questionnaire population according to the PHQ-9 score characteristics. The prevalence rate of moderate to severe depression among Chinese people was about 8.29%. Age, marital status, drinking, diabetes or hypertension, health care, economic well, COVID-19 vaccine, and HPV vaccine were potential influencing factors of anxiety and depression symptoms in Chinese people.

Linkage, Empowerment, and Access to Prevent Hypertension: A Novel Program to Prevent Hypertension and Reduce Cardiovascular Health Disparities in Detroit, Michigan

BACKGROUND

Serious cardiovascular health disparities persist across the United States, disproportionately affecting Black communities. Mounting evidence supports negative social determinants of health (SDoH) as contributing factors to a higher prevalence of hypertension along with lower control rates. Here, we describe a first-of-a-kind approach to reducing health disparities by focusing on preventing hypertension in Black adults with elevated blood pressure (BP) living in socially vulnerable communities.

METHODS AND RESULTS

Linkage, Empowerment, and Access to Prevent Hypertension (LEAP-HTN) is part of the RESTORE (Addressing Social Determinants to Prevent Hypertension) health equity research network. The trial will test if a novel intervention reduces systolic BP (primary outcome) and prevents the onset of hypertension over 1 year versus usual care in 500 Black adults with elevated BP (systolic BP 120-129 mm Hg; diastolic BP <80 mm Hg) in Detroit, Michigan. LEAP-HTN leverages our groundbreaking platform using geospatial health and social vulnerability data to direct the deployment of mobile health units (MHUs) to communities of greatest need. All patients are referred to primary care providers. Trial participants in the active limb will receive additional collaborative care delivered remotely by community health workers using an innovative strategy termed pragmatic, personalized, adaptable approaches to lifestyle, and life circumstances (PAL2) which mitigates the impact of negative SDoH.

CONCLUSIONS

LEAP-HTN aims to prevent hypertension by improving access and linkage to care while mitigating negative SDoH. This novel approach could represent a sustainable and scalable strategy to overcoming health disparities in socially vulnerable communities across the United States.

Efficacy of a Relaxation Scenario in Virtual Reality for the Comorbid Symptoms of Anxiety and Asthenia in a General Hospital Setting: A Pilot Comparative Randomized Open-Label Study

BACKGROUND

Patients in general hospitals often display concomitant signs of mental maladjustment: low mood, anxiety, apathy, asthenia, all of which can have a negative impact on the course of the underlying disease and the recovery process. One of the non-pharmacological approaches that has gained wider acceptance in medical practice in recent years is the use of procedures based on virtual reality.

AIM

Assess the efficacy of the new domestic, virtual reality application Flow as relates to symptoms of anxiety and asthenia in patients undergoing inpatient treatment.

METHODS

The study was open-label and had a comparison group; the patients were assigned to the experimental or control group using a randomization table. The patients were assessed using the Spielberger State Anxiety Inventory; the Fatigue Symptom Rating Scale; the Well-being, Activity, Mood questionnaire; the Depression Anxiety Stress Scale; and the Clinical Global Impression Scale. Physical parameters were measured before and after each virtual reality session. The obtained data were statistically processed.

RESULTS

The study involved 60 patients. In 40 patients, the treatment program included a course of five daily relaxation sessions in virtual reality; the control group consisted of 20 patients, who were treated in accordance with the usual practice of the institution. The addition of virtual reality sessions to the standard treatment course yielded significant advantage in terms of affective symptoms reduction in patients both after a single session and as a result of undergoing the full course, and several days after its completion. The patients in the experimental group also showed a significant decrease in blood pressure after the sessions, and this was most pronounced in individuals who initially had elevated and high blood pressure.

CONCLUSION

The use of relaxation program courses in the virtual reality application Flow is an effective and promising means of non-pharmacological care for non-psychiatric inpatients showing symptoms of anxiety, apathy, depressive mood, as well as hypertension.

Association between stressful life events and non-optimal lipid levels among women with hyperlipidaemia

AIMS

Psychological stress has been linked to lipid dysregulation with noticeable gender differences, but it remains unclear whether women are more susceptible to non-optimal lipid levels than men, when experiencing stressful life events. This study aims to examine the association between stressful life events and non-optimal lipid levels among persons with hyperlipidaemia and whether the association differs between men and women.

METHODS AND RESULTS

A nested case-control study was performed using data from the Wisconsin Sleep Cohort (WSC) Study from 2011 to 2015, including 224 participants with hyperlipidaemia and without a history of myocardial infarction or heart failure. Among them, 63 participants with non-optimal LDL cholesterol or triglyceride levels were identified as cases, and 161 participants with optimal LDL cholesterol and triglyceride levels were identified as controls. Cases and controls were traced back to their self-reported life events collected through the Retirement and Sleep Trajectories study during 2010-11. The association between stressful life events and non-optimal lipid levels was examined using multivariable logistic regression; confounding effects were addressed using propensity score weighting and Mahalanobis distance matching; gender differences were examined using subgroup analysis. Results showed that a higher number of stressful life events during 2010-11 was associated with greater odds of non-optimal lipid levels during 2011-15 (odds ratio = 1.45, P = 0.03) among women with hyperlipidaemia, whereas the association was not significant among men with hyperlipidaemia (P = 0.910).

CONCLUSION

Future studies are needed to examine the underlying mechanisms that explain gender differences in the association between stressful life events and non-optimal lipid levels.

REGISTRATION

ClinicalTrials.gov NCT00005557.

Cardiovascular risk factors in Sub-Saharan African women

Summary: Background: Cardiovascular risk factors (CVRF) are associated with major cause of death and disability in Sub-Saharan Africa, especially in women. The contribution of obstetrical, psychological, and socio-economic factors in CVRF are not yet well described in Africa. We aimed to compare the prevalence of CVRF between men and women, and to determine the factors associated to these sex-related differences. Patients and methods: A cross-sectional study was conducted on the 2019 data of the TAHES cohort in a geographically defined general population in Benin. A standardized questionnaire adapted from the World Health Organization (WHO) STEPS instrument was used to collect data. Univariate and multivariate analysis has been performed to determine CVRF differences in both sexes. Women-specific logistic regressions have been performed on CVRF previously identified as positively associated to female sex, to assess their association with socio-economic, psychological, and obstetrical factors. Results: We included 1583 patients, with a median age of 39 years [range: 32–53 years]. Prevalence of diabetes (1.2% vs. 3.4%, p=0.0042), abnormal kidney function (15.5% vs. 8.4%, p=0.0002), obesity (12.5% vs. 4.1%, p<0.0001), tobacco-smoking (3.4% vs. 14.1%, p<0.0001) and reduced physical activity (69.9% vs. 50.7%, p<0.0001) differed significantly between women and men, respectively. In multivariate analysis, female sex was independently and significantly associated with obesity, anxiety, depression and reduced physical activity. Number of pregnancies was associated with a reduced physical activity. Hypertension was associated with gestational hypertension. Conclusions: Obesity and reduced physical activity are significantly and independently more frequent in Beninese women than the male counterparts. Hypertension prevalence in Benin is alarming in both sexes. Targeted prevention strategies against obesity, gestational hypertension and sedentary lifestyle are advocated in African women.

Benzodiazepine-Receptor Agonist Utilization in Outpatients with Anxiety Disorder: A Retrospective Study Based on Electronic Healthcare Data from a Large General Tertiary Hospital

Benzodiazepine-receptor agonists (BZRAs), including benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs), are commonly used for anxiety, but often have side effects. We retrospectively investigated the utilization and prescription characteristics of BZRAs for patients with anxiety disorders in a large tertiary care general hospital between 2018 and 2021, based on electronic healthcare records. We also examined the pattern of simultaneous consumption of multiple BZRA drugs, and the diseases coexisting with anxiety that are associated with this. The numbers of patients and BZRA prescriptions increased over the 4 years. Moreover, 7195 prescriptions from 694 patients contained two or more BZRAs, of which 78.08% contained both BZDs and Z-drugs, 19.78% contained multiple BZDs, and 2.14% contained multiple Z-drugs. For anxiety patients with concomitant Alzheimer's disease or Parkinson's disease, and dyslipidemia, they were more likely to consume multiple BZRAs simultaneously, whereas patients with concomitant insomnia, depression, hypertension, diabetes, or tumors were less likely to consume multiple BZRAs (all p < 0.05). Furthermore, older patients who consume multiple BZRAs simultaneously may have higher probabilities of long-term drug use. Better interventions supporting standardized BZD utilization may be needed to minimize the side effects of inappropriate BZRA administration.

Neuroprotective Roles of Apelin-13 in Neurological Diseases

Apelin is a natural ligand for the G protein-coupled receptor APJ, and the apelin/APJ system is widely distributed in vivo. Among the apelin family, apelin-13 is the major apelin isoform in the central nervous system and cardiovascular system, and is involved in the regulation of various physiopathological mechanisms such as apoptosis, neuroinflammation, angiogenesis, and oxidative stress. Apelin is currently being extensively studied in the nervous system, and apelin-13 has been shown to be associated with the onset and progression of a variety of neurological disorders, including stroke, neurodegenerative diseases, epilepsy, spinal cord injury (SCI), and psychiatric diseases. This study summarizes the pathophysiological roles of apelin-13 in the development and progression of neurological related diseases.

Interaction of anxiety and hypertension on quality of life among patients with gynecological cancer: a cross-sectional study

BACKGROUND

Patients with gynecological cancer are prone to anxiety, and many of them are accompanied by hypertension, which seriously affects the quality of life (QOL). The study was to explore the interaction of anxiety and hypertension on QOL, and the moderating effect of perceived social support (PSS) in the impact of anxiety and hypertension on QOL of patients with gynecological cancer.

METHODS

A cross-sectional study was conducted in 2020, and 566 patients have been collected from the Affiliated Hospital of China Medical University. The Self-Rating Anxiety Scale (SAS), the Functional Assessment of Cancer Therapy Genera tool (FACT-G), and the Multidimensional Scale of Perceived Social Support Scale (MSPSS) were used. The interaction was analyzed by additive model, and the moderating effect was conducted by regression analysis and the simple slope analysis.

RESULTS

We found that 68.8% of patients had poor QOL due to the interaction between anxiety and hypertension. The relative excess risk ratio (RERI) was 22.238 (95%CI:44.119-88.596); the attribution ratio (AP) was 0.688 (95%CI:0.234-1.142); The interaction index (S) was 3.466 (95%CI: 0.823-14.435). The interaction items of PSS and anxiety were negatively correlated with QOL (β = -0.219, P < 0.01) and explained an additional 4.0% variance (F = 68.649, Adjusted R² = 0.399, ΔR² = 0.040, P < 0.01); PSS and blood pressure interaction item was not associated with QOL (β = 0.013, F = 55.138, Adjusted R² = 0.365, ΔR² = 0.001, P = 0.730).

CONCLUSIONS

When anxiety and hypertension coexist, the QOL was affected. PSS played a moderating role in the impact of anxiety on QOL. Healthcare providers should take intervention measures to improve patients' social support to reduce the impact of anxiety on QOL.

Mental health of UK firefighters

Exposure to trauma, high-stress situations, and disrupted sleep are well known risk factors affecting firefighters' mental health. Little is known about the association between firefighters' exposure to fire contaminants and mental health disorders. The UK Firefighter Contamination Survey assessed firefighters' health and capacity for occupational exposure to contaminants. Participants were invited to anonymously complete its 64 questions online. Logistic regression analyses assessed the associations between self-reported mental health disorders and proxies of contaminant exposure. Results found that firefighters who notice soot in their nose/throat for more than a day after attending fires (Odds Ratio (OR) = 1.8, 1.4-2.4), and those who remain in their personal protective equipment (PPE) for over 4 h after fires (OR = 1.9, 1.2-3.1), were nearly twice as likely to report mental health disorders. Significantly increased odds ratios for all three outcomes of interest (anxiety, depression and/or any mental health disorders) were also found among firefighters who take PPE home to clean. Sleeping problems were reported by 61% of firefighters. These firefighters were 4.2 times more likely to report any mental health disorder (OR = 4.2, 3.7-4.9), 2.9 times more likely to report anxiety (OR = 2.9, 2.4-3.5) and 2.3 times more likely to report depression (OR = 2.3, 1.9-2.8) when compared to firefighters who did not report sleep issues. Effective decontamination measures within UK Fire and Rescue Services, together with firefighters' wellness, may play a crucial role in protecting firefighters' mental health.

Association Analyses of Physical Fitness Parameters and Anxiety Symptoms in Chinese College Students

Poor physical fitness is related to many negative health outcomes, including mental disorders. However, the relationship between physical fitness and anxiety symptoms among college students remains unclear. Therefore, this study investigated whether physical fitness is related to anxiety symptoms in Chinese college students. Cross-sectional data were collected from 6635 men and 4482 women. Physical fitness was measured via a 50-m sprint, a sit-and-reach test, vital capacity, and a standing long jump for both sexes; 1000-m run and pull-up tests for males; and 800-m run and sit-up tests for females. The seven-item Generalized Anxiety Disorder Scale (GAD-7) was used to evaluate anxiety symptoms. Multivariate linear regression showed that better physical fitness was related to lower GAD-7 scores. In addition, multivariate logistic regression analysis showed that better ability in the 50-m sprint, sit-and-reach test, pull-up test, and vital capacity was related with a lower risk of anxiety symptoms in males, and better ability in the 800-m run and standing long jump was related with a lower risk of anxiety symptoms in females. In conclusion, physical fitness was inversely associated with anxiety symptoms in male and female college students. This association was also independent of confounding factors.

Prevalence and related factors of anxiety in first episode and drug naïve Chinese Han outpatients with psychotic major depression

BACKGROUND

Anxiety frequently occurs with major depressive disorder (MDD) but to a different extent in the various subtypes. Psychotic major depression (PMD) is a severe subtype of MDD that is under-identified and under-studied. We investigated the prevalence and related risk factors of anxiety in PMD patients.

METHODS

A total of 1718 first episode and drug naïve MDD patients were recruited. Measures included the Hamilton Depression Scale (HAMD), Clinical Global Impression-Severity scale (CGI-S), Hamilton Anxiety Scale (HAMA), and positive symptom scale of the Positive and Negative Syndrome Scale (PANSS), thyroid hormone levels, and metabolic parameters.

RESULTS

171 of the entire MDD study sample met the criteria for the PMD subtype. The prevalence of severe anxiety was much higher in PMD patients (22.8 %) than in non-PMD patients (0.4 %) (χ² = 294.69, P < 0.001, OR = 75.88, 95 % CI = 31.55-182.52). Compared to PMD patients without severe anxiety, PMD patients with severe anxiety had higher HAMD score, CGI-S score, positive symptom subscale score, suicide attempts, blood pressure, thyroid-stimulating hormone (TSH), anti-thyroglobulin (TgAb), and thyroid peroxidases antibody (TPOAb) levels. Furthermore, logistic regression analysis indicated that HAMD score and TSH levels were associated with severe anxiety in PMD patients.

LIMITATIONS

Our cross-sectional study cannot explain the causal relationship between anxiety severity and risk factors in PMD patients.

CONCLUSIONS

Our results suggest that PMD patients are more likely to experience severe anxiety than non-PMD patients. The severity of depression and TSH levels are independent risk factors for anxiety in PMD patients.

Self-Management and Its Influential Factors Among Individuals With Anxiety Disorders: A Cross-Sectional Study

Self-management has been proposed as a crucial pathway to recovery from mental disorders. The aim of the current study was to explore self-management and its influential factors among individuals with anxiety disorders. Data were from a cross-sectional survey of 180 individuals diagnosed with anxiety disorders. Sociodemographic characteristics, anxiety, self-management, and social support were investigated and analyzed. Participants' mean self-management score was 79.04, with a score rate of 63%. Economic burden, number of relapses, and anxiety severity significantly influenced self-management among participants. Increased social support was correlated with greater self-management. Mental health nursing services should be directed toward individuals with anxiety disorders. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 27-35.].

The circadian rhythm of blood pressure in patients with panic disorder and generalized anxiety disorder

BACKGROUND

Anxiety disorders affect blood pressure both during the day and at night. Little is known about the effect of individual anxiety disorders on the circadian rhythm of blood pressure.

OBJECTIVES

The purpose of this study is to compare the nocturnal drop in blood pressure in patients with panic disorder (PD), generalized anxiety disorder (GAD), and healthy individuals.

METHODS

The study was conducted on fifty consecutive outpatients with anxiety disorders and personality disorders who participated in intensive group psychotherapy. Diagnoses were made according to DSM-IV-TR criteria using the PSE-10 questionnaire. Out of 50 patients under study, 17 were diagnosed with PD and 21 with GAD. The control group consisted of 40 healthy people recruited in the course of other studies. The resulting three groups were compared in terms of circadian blood pressure using the ABPM method.

RESULTS

Mean nocturnal falls in systolic and diastolic blood pressure were the following: 2% and 3% (PD), 11% and 12% (GAD), 27% and 23% (control). Four people out of PD group had higher systolic and diastolic blood pressure at night than during the day. The ratios between non-dippers/dippers were: 0/15 (PD), 8/21 (38% - GAD) and 40/40 (100% - control).

CONCLUSIONS

The patients with PD were characterized by an almost flat course of circadian blood pressure. The patients with GAD had a lower mean nocturnal fall in blood pressure than the control group, but significantly higher than the patients with PD. The differences in the circadian course of blood pressure between PD and GAD are so large that the impact of these disorders should be investigated separately.