Anxiety, Depression, and Pain: Considerations in the Treatment of Patients with Uncontrolled Hypertension
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HYPERTENSION AND EMERGENCY MEDICINE (T RAINER AND P LEVY, SECTION EDITORS)
Anxiety, Depression, and Pain: Considerations in the Treatment of Patients with Uncontrolled Hypertension Mohamed Serhan Hamam 1 & Elizabeth Kunjummen 1 & Md. Shahed Hussain 1 & Mohamed Nasereldin 2 & Stephanie Bennett 1 & Joseph Miller 1,2 Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The association between mental health, pain, and treatment-resistant hypertension is an important consideration for treating physicians. We review and discuss the connection between conditions of anxiety, depression, and chronic pain and their effect on uncontrolled hypertension. Recent Findings There is significant co-occurrence of hypertension with anxiety, depression, and chronic pain which may lead to undertreatment of hypertension and undertreatment of the underlying mental health disorder. The association between mental health and hypertension is complex and is modulated by physiologic and environmental factors. Summary Physicians treating patients with hypertension should be cognizant of the role anxiety, depression, and chronic pain play in treatment efficacy and compliance. Patients undergoing treatment should be screened for mental health disorders at treatment initiation and frequently thereafter to ensure optimal overall health and compliance. Keywords Uncontrolled hypertension . Medication compliance . Anxiety . Pain . Depression
Introduction There has been considerable interest in the link between hypertension, anxiety, and pain in the recent literature given the significant disease burden and associated cardiovascular mortality. Approximately 45% of the adult US population live with hypertension and about 76% of those patients continue to be sub-optimally treated despite lifestyle and medication modifications [1••]. In addition, psychological comorbidities have been linked to worse cardiovascular outcomes [2–4]. With an estimated prevalence of 19.1% of the adult US population [5], anxiety has the potential to significantly worsen hypertension and alter disease progression. In addition to mental health, pain and perception of pain has similarly been associated with elevated blood pressure. We provide a review of the recent literature discussing This article is part of Topical Collection on Hypertension and Emergency Medicine * Joseph Miller [email protected] 1
Henry Ford Hospital, Emergency Medicine, Detroit, MI 48202, USA
2
Wayne State University, Detroit, MI 48202, USA
hypertension and its connection to pain and anxiety and how it relates to diagnosis, treatment, prognosis, and overall quality of life.
Anxiety and Hypertension Approximately 45% adults in the USA live with a diagnosis of hypertension [1••] and approximately 19% of the adult population suffers from disorders of anxiety [5]. Given the high prevalence of both diseases, it is important to understand the relationship between anxiety and hypertension. Data from the 2005 National Ambulatory Medical Care
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