Hypertension and psychiatry

Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels.

Systolic blood pressure is called maximum pressure. Systole is the name given to the contractions of the heart. Minimum pressure is the diastolic blood pressure, which is the name given to the period of time when the heart refills with blood after systole.

Hypertension carries many risks. Stroke is one of them. The risk of cardiac insufficiency, bleeding and oedema in the retina and other sensitive tissues are other examples of the risks involved.

If after measuring the blood pressure a few times, the average is equal or higher than 140/90 mmHg, it is diagnosed as hypertension.

Repression of anger is a real risk factor for hypertension. When people who are angry say “my blood pressure has shot up” it is probably this fact that they sense.

Hypertensive patients have to keep away from food items that contain salt and cholesterol.

Does every patient with hypertension also have to undergo a psychiatric examination?

The link between hypertension and stress is an important one. It is known since the 1930’s. Alongside with stress, depression is also one of the essential components of hypertension. Although in classical literature we do not come across anything that says that every hypertensive patient has to undergo psychiatric supervision, in my opinion it will undoubtedly be beneficial for the patient for this angle to also be considered. I believe that consulting a psychiatrist, at least with regards to the psychiatric complications associated with the management of nicotine addiction, diet, exercise, and compliance with the antihypertensive treatment, is advisable.

According to research carried out in the USA, hypertension also has a social dimension. Hypertension is more common in people of the lower income group who live in the suburbs. Well, in our country the percentage of the population who live in the suburbs and are of lower income is certainly considerable; I believe that it is therefore not pretentious to say that “our people have a high blood pressure”.

What do we come across in personality assessments of hypertensive patients?

The most significant characteristic we know about, is suppressed anger.

Hypertensive patients are usually fairly angry people. They may not be very good at forming social relationships or keeping these on a smooth path. Therefore we often come across discord in their relationships.

Hypertension can lead to cognitive changes. As we know, cognitive processes are an important part of our personality. A person’s ability to plan, to execute the plan and to end it are all displays of cognitive abilities. If there is a problem in these functions the person may become intolerant to obstacles. He may get angry and lose his temper. If his behaviour varies greatly from his previous personality, it becomes really noticeable.

Unmanaged hypertension can lead to serious sexual dysfunction both in men and women. This too is an area that requires psychiatric support.

There is a phenomenon called nocturnal penile tumescence (NPT). The erection of the penis during REM sleep is referred to by that name. NPT is common in hypertension cases. This shows that the event is caused by an organic aetiology rather than by stress. It is more vascular in origin.

There is a close link between panic disorder and cardiovascular illnesses.

There are many similarities between the mechanisms of depression and hypertension. If there is a dysfunction, it would be wise to look for other symptoms of depression.

With regards to an association with hypertension, the main groups of illnesses are depression, dementia, panic disorder, marked personality disorders, sexual dysfunctions.

With regards to mortality and morbidity, hypertension is one of the major threats to public health.

Factors that increase frequency of occurrence are nutritional deficiencies, sedentary lifestyle (lack of exercise) nicotine or alcohol dependency or dependency on other substances, stress factors like poverty etc.

It is a known fact that there is a close link between hypertension and primarily smoking, but also with the use of alcohol and other substances.

Due to their restricted life style sufferers of hypertension experience social and psychological adjustment problems.

Hypertension is a symptom. In 90-95% of all cases its cause is unknown. However its association with kidney disease, Cushing’s and similar diseases should always be kept in mind, as these diseases require an entirely different treatment strategy. In other words, hypertension should not just be labelled as being ‘of unknown cause’ or ‘genetic’, and then left at that.

The cause of what is called White Coat Syndrome is unknown. Although everything is fine, the person’s blood pressure rises when he stands in front of a doctor. The predominant belief is that this is more stress-related.

Hypertension is one of the main causes of headaches. However, as pain is not always experienced, hypertension can progress underhand and unnoticed.

Sleep rhythm disorder is a common picture in hypertensive patients.

With age the compliance of the blood vessels deteriorates in a person. Furthermore, pathological processes like atherosclerosis become more widespread. This is the reason why hypertension is more an illness of the elderly.


Firstly the aetiology is investigated. It is investigated whether or not there is an underlying pathology related to the vascular system or the kidneys etc. If there is, then treatment will address the cause. Otherwise treatment with anti-hypertensive drugs is commenced. If there is an accompanying psychiatric picture of depression or similar, then these will be addressed. At that point particular care has to be taken to ensure that the drugs given to the patient are not of the type that can lead to a blood pressure crisis. Treatment techniques other than drugs can consist of meditation, bio-feedback and relaxation techniques whose benefits are undoubted.