Association Between Anxiety and Hypertension in Adolescent Patients: A Single-Center Cross-Sectional Study

Author Type(s)

Faculty, Resident/Fellow

Document Type

Abstract

Publication Date

2022

DOI

10.1681/ASN.20223311S1442c

Journal Title

Journal of the American Society of Nephrology

Department

Pediatrics

Abstract

Background: Given its rising prevalence, identifying modifiable risk factors of primary pediatric hypertension remains an area of active research. Anxiety is a common childhood problem that may be associated with activation of the sympathetic system, plasma renin, and hypothalamic-pituitary-adrenal axis; thus, resulting in increased peripheral vascular resistance and hypertension (HTN). While anxiety is known to be associated with elevated blood pressure (BP) in adults, this has not been studied in children. The objective of this study was to assess the association between anxiety and HTN in adolescents. Methods: Adolescents, aged 12 to 18 years old, referred to our Pediatric Nephrology clinic were eligible to participate. HTN was defined as either systolic (SBP) or diastolic (DBP) BP above the 95th percentile for age, height, and gender. Participants were evaluated for anxiety using the validated Screen for Child Anxiety Related Disorders questionnaire filled independently by child (SCARED-C) and a parent (SCARED-P) evaluating the child. A score of ≥ 9 was defined as a positive screen for anxiety. Proportions were compared using chi-square tests and difference in blood pressure between groups compared with the Mann-Whitney U test. Results: 200 adolescents participated in this study with a subgroup of 130, not on any blood pressure medication. In this subgroup, the mean age was 15.18 ± 1.7 years, 50% were male. 45% (58) had positive SCARED-C and 29% (37) positive SCARED-P scores. 43% (16) of SCARED-P positive had diastolic HTN compared to 19% (18) of SCARED-P negative, p = 0.005. DBP was significantly higher in SCARED-P positive (79.0±10.1) and SCARED-C positive (77.1±10.4) compared to SCARED-P negative (73.6±9.3) and SCARED-C negative (73±8.9) groups respectively (Table 1). Conclusions: In this cohort of adolescents, those who were anxious by parental reporting were more likely to have diastolic HTN. For adolescents not treated with antihypertensive medications, DBP but not SBP was significantly higher in the anxious cohort both by self and parental reporting. The impact of anxiety on the pathogenesis of HTN in children warrants further study.

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