Psychophysiological disorders in anxious patients: hypertension and hypotension

Anxious patients have a higher incidence than the general population for cardiovascular disorders and sudden death. Several studies have emphasized abnormal pulse rate, abnormal heart response conditioning, high incidence of arrhythmia, and abnormal blood pressure. Essential hypertension has been studied in relation to stress, and chronic hypotension ('low blood pressure syndrome') has been clinically recognized for decades, but rarely systematically studied. We investigated these abnormal blood pressures in anxious patients, during controlled trials with 80 patients having generalized anxiety disorder as defined in DSM III, for at least 6 months duration, and of moderate to severe intensity. They were randomly assigned to placebo, or bromazepam, 18 mg/day. Blood pressure, pulse, and several other measurements were taken on a weekly basis for 2 months (washout phase--1 week, treatment phase--4 weeks, and withdrawal phase--3 weeks). One third of these patients had an abnormal blood pressure (hypertension or hypotension) while untreated, and this is statistically significant when compared to a matched control group of nonanxious patients. Bromazepam improved several patients having either hypertension or chronic hypotension. These findings are relevant for long-term treatment of anxious patients, since cardiovascular psychosomatic complications are a major health problem.