By Markham Heid
April 24, 2019

Anxiety is part of life. You feel it when you’re stuck in traffic, harried at work or worrying about your family and finances. There’s no doubt that feeling anxious can elevate your blood pressure, at least in the short term.

“Our mind and our thoughts certainly are connected to our hearts,” says Dr. Christopher Celano, associate director of the Cardiac Psychiatry Research Program at Massachusetts General Hospital. When something makes you anxious—whether it’s a life-threatening emergency or persistent worry—your sympathetic nervous system initiates a fight-or-flight response that raises your heart rate and blood pressure, he explains.

This is fine—and maybe even beneficial—in moderation. “A little anxiety can be motivating,” he says. It can help you start a new exercise routine or make healthier food choices. But it needs to be balanced out by parasympathetic nervous system activity. “The parasympathetic nervous system helps you relax, and a balance between the parasympathetic and sympathetic nervous systems is essential for heart health,” he says.

Some people with anxiety don’t have this balance, and over time this could imperil the heart. “When people are chronically anxious, they may experience changes to their immune system, blood vessels, and platelets that may contribute to heart disease,” he says.

Research bears this out. A 2015 research review found that people who experience high levels of anxiety are more likely to develop hypertension than those who aren’t as anxious. When a person’s anxiety levels are elevated for long periods of time, the resulting nervous system activity could raise blood pressure and promote arterial disease, the authors of that review write. But a lot of the evidence they turned up was inconsistent or inconclusive, they point out. Some contradictory research has even found that anxiety is associated with a slightly lower risk of hypertension.

The tricky thing is establishing an unambiguous cause-and-effect relationship between anxiety and high blood pressure, says Dr. James Brian Byrd, a hypertension specialist and assistant professor 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 contribute to the development of sustained hypertension,” 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.

Some of Celano’s research has shown that, among people with heart disease, anxiety is associated with increased mortality. While that doesn’t prove that anxiety earlier in life caused or contributed to their heart problems, he 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 inventory (STAI). The STAI asks people to rate, on a scale from “not at all” to “very much,” whether they’re feeling calm, secure, tense, strained, frightened, etc.

Celano offers more straightforward criteria. “Try to distinguish whether or not the anxiety is so severe 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 hypertension and heart trouble, he says.

“Talk with a physician or other provider about it,” he advises. There are a number of ways to deal with it—from meditation and relaxation response training to medication, he says.

Even if it turns out that 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,” he says.

A steady state of high anxiety isn’t something you should ignore.

Contact us at editors@time.com.

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