Anxiety and blood pressure: what's the link?

Stress is everywhere—it is impossible to avoid it. Stress can be positive or negative; it can help you meet that important deadline at work, or it can have you tossing and turning at night. Stress is a response to situations in your life. Anxiety, however, is a reaction to stress in your life. People with anxiety have excessive worry and fear about some aspect of their life; this overwhelming apprehension and doubt may be accompanied by anxiety symptoms like tense muscles, sweating, increased heart rate, etc.

If these symptoms sound familiar, that is because they are the same symptoms you get when the sympathetic nervous system, or “fight or flight” response, activates. When you are under stress or having anxiety about a stressful situation, your body releases cortisol (also called the “stress hormone”) as part of the “fight or flight” response. Cortisol affects many parts of your body, including your heart; elevated levels of cortisol cause an increase in heart rate and constricts (squeezes) blood vessels, leading to a rise in blood pressure. This is a short-term response, and the effects disappear when the stressful trigger is gone.

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According to the American Heart Association (AHA), hypertension is when your blood pressure is consistently too high (AHA, 2016). Why is that bad? Blood pressure refers to the force of your blood pushing against the walls of the blood vessels with each heartbeat. This elevated force causes damage to the inner lining of your blood vessels, leading to a hardening of your arteries and the development of atherosclerosis (fatty plaques).

As atherosclerosis worsens, the blood vessels narrow, and this causes a further increase in blood pressure because you have the same amount of blood trying to go through a smaller channel. Also, as the blood vessel narrows, less blood gets to the heart muscles, and they can weaken due to lack of oxygen and nutrients. Over time, hypertension can lead to heart disease, heart attacks, stroke, vision loss, sexual dysfunction, and kidney disease.

There are several theories to explain how stress and anxiety may lead to long-term high blood pressure, but there is no definitive proof that stress by itself causes hypertension. Activation of the “fight or flight” response involves an increase in blood pressure, the precursor to hypertension. Even though the increased blood pressure returns to normal after the stressor is gone, when you are under chronic stress and anxiety, you may have frequent temporary blood pressure spikes. Episodes of anxiety, like panic attacks, can also cause a dramatic rise in blood pressure, albeit temporary. These transient spikes can lead to blood vessel damage and cardiovascular disease over time; this is similar to what happens in people with hypertension.

Another reason that chronic anxiety and stress can contribute to hypertension, according to the AHA, is that some people respond to stress and anxiety with unhealthy habits that can themselves increase the risk of hypertension (AHA, 2014). These include overeating or eating a diet high in sodium and fat, an increase in alcohol or drug use, smoking, or lack of exercise. These unhealthy habits are known risk factors for high blood pressure and can lead to hypertension.

While you cannot avoid stress, you can make changes in your life to help with managing stress. The National Institute of Mental Health (NIHM) and the AHA recommend the following ways to cope with stress (AHA, 2016): 

• Engage in physical activity regularly; even walking can help.

• Eat a healthy diet.

• Try a relaxing activity like meditation, yoga, and taking slow deep breaths.

• Identify the aspects of your life that are under your control, like what you need to do now and what can wait.

• Learn to say “no” if you feel like there is too much on your plate.

• Schedule time for yourself. Start a hobby, curl up with your favorite book, or just do something you enjoy.

• Know your stress triggers and avoid them whenever possible.

• Have a support system- friends, family, community, religious organization, and others can be a source of help and support when you are feeling stressed.

• Get professional help if you feel that you cannot reduce stress on your own.

Anxiety can be a medical condition, especially if it becomes overwhelming and affects your life; when this happens, it is likely due to an anxiety disorder. Over 30% of people in the U.S. will experience an anxiety disorder at some point in their lives. If you find yourself unable to deal with your anxiety or that your anxiety is stopping you from doing the things that you want to do talk with your healthcare provider (NIHM, 2017). For some people, treatment of their anxiety may require medication and therapy, in addition to managing stress with the tactics listed above. Do not be afraid to ask for help if you need it. You are not alone.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

December 13, 2019

Written by

Chimene Richa, MD

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.