Throbbing Anxiety: Hypertension and Panic

Many people see a connection between hypertension and stress or anxiety. But a new study suggests a link to an especially terrifying condition.

By Owen C. Franklin

Imagine your own body waking you in the middle of the night — your blood rushes audibly through your ears, your hands and feet burn and freeze at the same time, and your vision throbs with every surging heart beat.

This happened just a few months ago to Darlene, a middle aged woman who preferred to keep her last name anonymous. Darlene has hypertension, and expects periodic problems of racing blood pressure. This episode, however, was unlike anything she'd experienced before.

When Darlene grabbed her blood pressure monitor to gauge how the trauma was playing out beneath her skin, she read the numbers 187 and 116. She called her local hospital and was told to come to the emergency room.

Through the night hours, the staff administered oxygen, blood and urine tests, and kept Darlene on an automatic blood pressure cuff. Darlene didn't know what she was treated for until she received the hospital bill.

"I read the bill and it said I had a panic attack," said Darlene. "There I was thinking, 'they think I'm crazy!'"

But new research may absolve Darlene's fear of mental stigma. A recent study points to a link between panic attacks and the surging beats of hypertension.

The British study, published in the American Journal of Medicine, surveyed 702 people, half of whom had hypertension. Investigators listed 13 characteristics that could be felt during the onset of panic, such as shortness of breath, fear of going crazy, and feelings of being "outside" the body. In the study, a panic attack was diagnosed when a subject experienced four or more of these characteristics.

Once the results were analyzed, the researchers found that twenty-four percent of the hypertensive subjects reported experiencing panic attacks, compared to only twelve percent of non-hypertensive patients.

This study may click with many people's perceptions of hypertension. For many people, the stereotypical hypertensive is a stressed-out, overly anxious individual. It would make sense to assume that the temperament that fans the fire of high blood pressure could also spark the occasional panic attack.

Unfortunately, hypertension doesn't lend itself to easy answers. While stress may increase blood pressure, studies indicate that stress is not the definitive source of hypertension. The spectrum of factors that contribute to this disease, such as heredity, gender and weight, pose a problem to broad-stroke solutions.

"Hypertension is extremely hard to pin down," said H. Mitchell Perry Jr., M.D., who runs the hypertension division at the Washington University School of Medicine. "We still don't know the mechanism for hypertension, or even if there is one."

The study on panic attacks and hypertension did not clarify if or how one condition contributed to another. The study simply suggested that a portion of the hypertensive population might be experiencing more panic attacks than do people without hypertension.

Such "descriptive" studies abound in hypertension research, especially those that concern such factors as stress. Descriptive studies correlate one condition with another without suggesting why the two factors may go side by side. Examples of these studies include hypertension's relationship to job-related stress, the emotional stimulus of an IQ test, and the grind of a long commute.

"There have certainly been attempts to look at the relationship between hypertension and various psychological and psychiatric effects," said Dr. Perry. "They haven't really helped us understand a mechanism of hypertension that you could apply to 50 million people."

Many authorities may question a study that relates a physiological condition such as hypertension to a seemingly psychological condition such as panic. However, a great number of medical experts dedicate their studies to "mind/body" connections. Here, researchers explore such bodily "channels" as those between the brain and heart, lungs and endocrine system.

"The mind is basically the controlling influence," said Helen Kogan Budzynski, Ph.D., professor emeritus of psychosocial and community health at the University of Washington in Seattle. "It controls the stream of factors that finally end up producing the hypertensive-state."

By pinpointing our bodily links, researchers may find new methods of treating health challenges. In her studies, Dr. Budzynski analyzed a particular mind/body approach to managing hypertension.

"Patients can attempt to alter their physiology through relaxation technique," said Dr. Budzynski. "Probably the best technique is abdominal breathing."

Dr. Budzynski and her coworkers trained 60 patients to breathe deeply and slowly. The idea was to teach people to "synchronize" their heart rate with their breathing patterns.

"We saw significant results," said Dr. Budzynski. "At the end of the study, all but eight of them went off their blood pressure medication."

Still the right breathing pattern can't relax every person who feels stress of panic from time to time. Even if it could, relaxation can't offer end-all treatment for hypertension. Medical research, to date, can't untangle the list of factors that contribute to each respective case of hypertensive.

"They say we don't know the mechanism of hypertension," said Dr. Budzynski. "I think we know too many and just don't know how they interrelate."

The study that suggests a relationship between panic and hypertension may not offer a cure for either condition. However, medical research builds upon itself, and each effort brings us closer and closer to effective treatments.

"There is certainly a place for this kind of study," said Dr. Budzynski. "These descriptive studies that correlate one thing to another offer us a beginning to do more research."