Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies

Background: Epidemiological studies have repeatedly investigated the association between anxiety and hypertension. However, the results have been inconsistent. This study aimed to summarize the current evidence from cross-sectional and prospective studies that evaluated this association. Methods: Seven common databases were searched for articles published up to November 2014. Cross-sectional and prospective studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratios or hazard ratios, and 95% confidence intervals (CIs) were extracted or calculated by the authors. The pooled odds ratio was calculated separately for cross-sectional and prospective studies using random-effects models. The Q test and I-2 statistic was used to assess heterogeneity. A funnel plot and modified Egger linear regression test were used to estimate publication bias. Results: The search yielded 13 cross-sectional studies (n=151,389), and the final pooled odds ratio was 1.18 (95% CI 1.02-1.37; P-Q<0.001; I-2=84.9%). Eight prospective studies with a total sample size of 80,146 and 2,394 hypertension case subjects, and the pooled adjusted hazard ratio was 1.55 (95% CI 1.24-1.94; P-Q<0.001; I-2=84.6%). The meta-regression showed that location, diagnostic criteria for anxiety, age, sex, sample size, year of publication, quality, and years of follow-up (for prospective study) were not sources of heterogeneity. Conclusion: Our results suggest that there is an association between anxiety and increased risk of hypertension. These results support early detection and management of anxiety in hypertensive patients.