Psychiatric Aspects of Hypertension

¹ Head of the General Practitioner Research Group, 325 Staines Road, Twickenham, TW2 5AX
² Psychopharmacology Research Branch, National Institute of Mental Health, U.S. Public Health Service
³ Biometric Laboratory, George Washington University, Washington, U.S.A.

The rationale for undertaking this survey was based on the evidence quoted, demonstrating that psychological factors may play a part in the aetiology of hypertension. In fact, the survey showed that anxiety symptoms are relatively common and symptoms of depression and anger-hostility are not; although there were no significant differences between the hypertensive patients and their control groups. Anxiety, although mainly mild or moderate, would seem to be present in a high proportion of hypertensive patients, whether newly diagnosed or receiving hypotensive drug therapy. However, our evidence does not suggest a causal relationship between anxiety and hypertension.

The only positive findings in the survey were the significantly increased pulse rate in the new hypertensives compared to all three other groups, the greater variance of systolic levels when no psychotropic drugs had been used, and the high level of hypertensive complications in the old cases under treatment, compared to their controls. It seems probable that the more rapid pulse rates recorded in the new hypertensives may have been associated with the stress situation induced on learning the diagnosis. Certainly there was no evidence that this was associated with any higher level of anxiety symptomatology. Since this raised pulse rate was absent in the old hypertensives, there is no means of knowing how long it may have persisted, or whether it may have been quickly relieved by hypotensive drug therapy.

The differences in the variance of systolic pressure in relation to the use or not of psychotropic drugs, are only of possible significance. The numbers of patients involved were small, and the possible interpretation indirect. Nevertheless, it is possible that the use of an anti-anxiety drug might, in fact, prevent the `swing' of systolic pressure which may occur from time to time and which may well be connected with the occurrence of hypertensive complications, such as cerebrovascular accident etc. That such complications still occur fairly frequently, despite hypotensive drug therapy, is apparent from the results of the survey.

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