and promote arterial disease. But a lot of the evi-
dence was inconsistent or inconclusive, the authors
pointed out. Some contradictory research has even
found that anxiety is associated with a slightly lower
risk of hypertension.
The tricky part of this research is establishing an
unambiguous cause-and-effect relationship between
anxiety and high blood pressure, says James Brian
Byrd, a hypertension specialist and an assistant pro-
fessor of cardiovascular medicine at the University
of Michigan Medical School. Ask someone to deliver
an impromptu public speech, and their heart rate
will almost surely shoot up, Byrd says. “However, it
is harder to tell whether frequent anxiety can con-
tribute to the development of sustained hyperten-
sion,” he says. “The issue is not settled.”
Still, the links between chronic anxiety and
higher rates of hypertension and heart problems are
worth taking seriously. “People who have anxiety all
the time and worry about a lot of different things—
those are probably people who are going to be more
at risk for heart disease and hypertension in the long
run,” says Celano.
One of Celano’s studies, published in the Ameri-
can Heart Journal, showed that among people with
heart disease, anxiety is associated with increased
mortality. Although that doesn’t prove that anx-
iety earlier in life caused or contributed to their
heart problems—in fact, the researchers found that
depression, which often accompanies anxiety, was
more strongly linked to mortality—Celano says it
makes sense that constant worrying would, over
time, promote heart and blood pressure issues.
How can you tell if your anxiety is the type that
could hurt your heart in the long run? That can be
difficult. Doctors and clinicians tend to use lengthy
questionnaires, such as the State-Trait Anxiety In-
ventory (STAI). The STAI asks people to rate, on
a scale from “almost never” to “almost always,”
whether they’re feeling calm, secure, tense, strained,
frightened and more—with 40 measures in total.
Celano offers more straightforward criteria. “Try
to distinguish whether or not the anxiety is so se-
vere that it’s impacting [your] life or functioning,”
he says. If you feel like you worry too much about
a variety of things on most days and this anxiety is
messing with your sleep or mood or relationships,
then that’s the type of anxiety that could lead to hy-
pertension and heart trouble.
“Talk with a physician or other provider about it,”
he advises. There are a number of ways to deal with
it, from mind-body approaches like meditation and
relaxation response training to medication, he says.
Lifestyle changes—including exercising, sleeping
well, eating a healthy diet and cutting caffeine—can
also help ease anxiety for some people.
Even if anxiety by itself doesn’t contribute to
heart disease, keeping your worrying in check is still
important. “Irrespective of whether chronic anxiety
contributes to hypertension, managing anxiety and
stress is an important aspect of maintaining a high
quality of life,” Byrd says. A steady state of high anxi-
ety isn’t something you should ignore. •