Can anxiety cause high blood pressure?

All of us feel anxious at times—maybe you’re nervous about a presentation or you’re stressed about arriving somewhere on time. You may joke that you can feel your blood pressure rising. But if you experience anxiety on a regular basis, should you be worried about it also causing high blood pressure? 

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Anxiety and blood pressure: What’s the link? 

Anxiety is the body’s physical response to stress. Heavy breathing, feeling “butterflies” in your stomach, or getting a sudden burst of energy are all physical manifestations of anxiety. Feeling anxious at times is completely normal and can even be helpful in certain situations. We all have a fight or flight response, like if you saw a bear in the woods your body would generate the epinephrine needed to run quickly. When you experience these short episodes of anxiety, increased heart rate and a short-term blood pressure spike is both likely and helpful. “Blood pressure varies moment to moment in all people,” says Evan Jacobs, MD, primary care physician at Conviva Care Center in Parkland, Florida. “Stressors such as pain, discomfort, or anxiety will elevate blood pressure temporarily and this is a normal reaction.” 

Long-term high blood pressure, also known as hypertension, isn’t just the temporary result of a stressful situation—it’s when blood pressure is consistently too high, according to the American Heart Association. Hypertension is a common health condition, nearly half of American adults have it. When patients have uncontrolled elevated blood pressure, it may make patients feel anxious. When blood pressure is controlled with medication, patients often feel calmer and less jittery.

So, can anxiety cause high blood pressure? It’s unclear to researchers whether experiencing frequent episodes of anxiety or having an anxiety disorder directly increases the risk of having chronic high blood pressure. They do know that chronic anxiety and anxiety disorders—like general anxiety or social anxiety—are associated with cardiovascular disease and have been linked to adverse cardiovascular outcomes, including hypertension. The “why” isn’t clear. Maybe anxious people use unhealthy behaviors like smoking, excessive alcohol use, or overeating as coping mechanisms. Each of these activities are risk factors for high blood pressure. 

Additionally, mental health and physical health are linked, says Georgia Gaveras, DO, the chief psychiatrist at Talkiatry. “Anxiety can be related to increased blood pressure, and to protect one, we must protect the other.”

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What is white coat syndrome?

One interesting phenomenon related to anxiety and hypertension is white coat syndrome or white coat hypertension. This occurs in 15% to 30% of patients who have a rise in their blood pressure due to nerves or anxiety when they are in a clinical setting, such as a dentist’s or doctor’s office (hence the “white coat” name). In fact, this type of anxiety can raise blood pressure by 10 points. It’s a concern for patients because they may be prescribed unnecessary medication that can have detrimental side effects. What makes it even trickier is that white coat syndrome can sometimes be an early warning sign for actual hypertension. 

Luckily, it’s unlikely that a doctor will prescribe medication or treatment based on one high blood pressure reading. If you or your doctor believe you may be experiencing white coat syndrome, it’s likely you’ll be asked to monitor your blood pressure readings at home or wear an ambulatory blood pressure monitor for a few days to get a more accurate depiction of your blood pressure. Blood pressure goals are under 135/85 mmHg.

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Anxiety and high blood pressure medication

Treating anxiety and/or high blood pressure is important to your health, but you may be wondering if medication could make either condition worse. The answer? It depends. 

“Most of the typical medications used to treat anxiety actually tend to lower blood pressure by blunting the stress response to anxiety,” Dr. Jacobs says. 

In fact, beta blockers, a commonly prescribed medication for hypertension and heart disease, are also prescribed as an off-label drug for anxiety. On the flip side, if you’re prescribed a serotonin-norepinephrine reuptake inhibitor (SNRIs), monoamine oxidase inhibitors (MAOIs), or norepinephrine-dopamine reuptake inhibitors (NDRIs), which are antidepressants, there’s a chance that it can raise blood pressure. SSRIs are not known to cause hypertension. If blood pressures increase with SNRIs this may be related to the potency of norepinephrine effects. SNRIs may cause transient hypertension, but rarely lead to medication-dependent treatment. MAOIs are a drug class that is rarely used anymore. But, it’s important to know that MAOIs may cause hypertensive crisis, especially if the medication interacts with another medication or a food. It is good practice to take your blood pressure twice a week after starting any new medication to confirm that your blood pressure is maintaining less than 135/85. 

If you are being treated for both an anxiety disorder and hypertension, it’s important to disclose all medications you’re taking with all your doctors and follow medical advice so they can design a treatment plan that works to improve both conditions concurrently. 

How to manage symptoms

If you’re experiencing anxiety and/or high blood pressure readings, incorporate these lifestyle changes and take prescribed medication:

1. Exercise daily 

Keeping physically active helps reduce anxiety and improves heart health. Even a 10-minute walk may be just as good for your mental health and wellness as a longer workout. Physical activity releases feel-good hormones, called endorphins, that can have lasting effects. Making exercise a regular habit has long-term effects, too, such as training the brain to help cope with stress even better. 

Exercising more doesn’t mean you have to go from being a couch potato to a marathon runner overnight. The best exercise for you is the one that you do: hiking, dancing, going on long walks while listening to podcasts, or weightlifting. Check with your doctor to confirm that it is safe to start a new routine. 

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2. Reduce alcohol 

While unwinding with a glass of wine or a bottle of beer can feel good, it’s likely doing more harm to your anxiety and high blood pressure. Initially, alcohol works as a vasodilator, which causes blood vessels to relax and blood pressure to decrease. However, high levels of alcohol can work as a vasoconstrictor, which causes blood vessels to narrow and blood pressure to increase. And if you’re drinking alcohol over several days, it can lead to a sustained increase in blood pressure—one that doesn’t decrease after a few drinks and can lead to an increased risk of hypertension.

If you find yourself drinking a few days a week, you may also be drinking more calories than you’d like or making food choices you wouldn’t otherwise make. These decisions can lead to weight gain and thereby increase your risk of high blood pressure. 

And when it comes to anxiety and stress levels, alcohol often exacerbates it. In fact, there’s even a word for it—“hangxiety.” While you may feel less stressed while drinking, as the alcohol wears off, quite often you’ll feel worse than when you began drinking. It’s estimated that 20% of people with social anxiety disorder also experience some type of alcohol dependence. If you’re trying to reduce anxiety or your blood pressure, drinking alcohol less frequently can help. 

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3. Meditate 

If you’re looking for something that you can do anywhere, at any time, to reduce high blood pressure and ease anxiety, meditation is it. Studies have found that meditating can produce “small yet meaningful” reductions in blood pressure, either on its own or with medication. 

Meditation techniques like slowing down your breath, concentrating on your breathing, and deep breathing also help with anxiety. You can incorporate these helpful techniques throughout your day to ground yourself and reduce the physical symptoms of anxiety. There are many apps that offer guided meditations to help incorporate the practice into your life. 

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4. Get more (and better) sleep 

If you’re frequently cutting your sleeping hours short, you may be paying for it. Researchers know that skimping on sleep can lead to higher blood pressure. But it turns out that it’s not just how much time you spend in bed that matters, but also the quality of rest. A recent study found that people who had lower sleep efficiency—the amount of time in bed that’s spent sleeping soundly—showed an increase in blood pressure both that night and the next day. SingleCare’s 2021 sleep survey found that 24% of respondents lie awake at night feeling worried, depressed, or anxious.

Getting enough high-quality sleep can be difficult if you have anxiety, but not sleeping enough can worsen the condition, as it can make you more irritable and increase anxious responses. So what’s an anxious person to do? Adding meditation to your nighttime routine can help. Avoiding coffee and alcohol in the afternoons and evenings can also make it easier to fall asleep. Keeping your phone out of bed and picking up a book instead can help get your brain into sleep mode. 

5. Find a safe anxiety medication for hypertension

There are medications that can treat anxiety without negatively impacting your blood pressure. Ask your healthcare provider if hydroxyzine, a beta blocker, SSRI, or benzodiazepine could help your mood, along with your hypertension. Some anti-anxiety medications, like diazepam, might even bring down your blood pressure. Diazepam is a controlled substance, requiring frequent doctor visits and may cause addiction. So, diazepam is only used as a last resort.