title: Anxiety disorder is associated with nocturnal and early morning hypertension with or without morning surge: ambulatory blood pressure monitoring.
abstract: BACKGROUND
  Nocturnal and early morning hypertension are both significant risk factors for cardiovascular events. It remains unclear whether anxiety disorder affects nocturnal blood pressure (BP), early morning BP, or BP pattern in hypertensive patients.
  
  
  RESULTS
  One hundred and twenty consecutive hypertensive outpatients (77 men and 43 women; mean age, 66±11 years) were divided into 2 groups based on Hospital Anxiety and Depression Scale (HADS) score: a control group (n=78; HADS ≤10) and an anxiety group (42 patients; HADS ≥11). Nocturnal BP, early morning BP, morning BP surge (defined as BP rise ≥50 mmHg), and BP pattern (extreme-dipper/dipper/non-dipper/riser) were measured on ambulatory BP monitoring. Clinical characteristics and BP were also evaluated at physician check-up. There was no significant difference between the 2 groups for BP check-up, but nocturnal and early morning BP were significantly higher in the anxiety group (142±16 mmHg and 152±21 mmHg) than in the control group (126±14 mmHg and 141±18 mmHg). With regard to patients with morning BP surge, nocturnal and early morning BP were also significantly higher in the anxiety group. The relative risk of existing anxiety disorders in riser-type hypertension was 4.48-fold higher (95% confidence interval: 1.58-12.74; P<0.005) than in dipper-type hypertension.
  
  
  CONCLUSIONS
  Anxiety disorder is associated with nocturnal and early morning hypertension, and may be a risk factor for cardiovascular events.
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan. h-kayano@med.showa-u.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kayano
authors.forename: Shinji
authors.initials: S
authors.lastname: Koba
authors.forename: Taiju
authors.initials: T
authors.lastname: Matsui
authors.forename: Hiroto
authors.initials: H
authors.lastname: Fukuoka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Toshida
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sakai
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Akutsu
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanno
authors.forename: Eiichi
authors.initials: E
authors.lastname: Geshi
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology; D013997:Time Factors