Mental Illness Wreaks Havoc on Both the Mind and the Heart
Background:
Mental illness represents a significant global burden of disease worldwide. It has been hypothesized that people with mental illness have greater blood pressure fluctuations leading to increased cardiovascular risk and target organ damage.
This systematic review aims to (i) investigate the association between mental illness and blood pressure variability (BPV) and (ii) describe methods of BPV measurement and analysis that may affect the pattern and degree of variability.
Methods:
Four electronic databases were searched from inception to 2020. Quality assessment was performed using STROBE criteria. Studies were included if they investigated VBP (including frequency or time domain analysis) in people with mental illnesses (particularly anxiety/generalized anxiety disorder, depression/major depressive disorder, panic disorder, and hostility) and without hypertension. Two authors independently screened titles, abstracts, and full texts. A third author resolved any disagreements.
Results:
Twelve studies met the inclusion criteria. Three studies measured short-term BPV, two measured long-term BPV, and seven measured ultra-short-term BPV. All studies related to short-term BPV that used ambulatory and home blood pressure monitoring found higher BPV in people with depression or panic disorder.
The two studies that measured long-term BPV were limited to the older population and found mixed results. Mental illness is significantly associated with increased BPV in young and middle-aged adults.
All ultra-short-term BPV studies using standard cardiac autonomic assessment; Continuous non-invasive finger blood pressure and heart rate signals found a significant association between BPV and mental illness. A mixed result was observed related to the degree of tilt during tilt assessment and between controlled and spontaneous breathing in patients with psychological status.
Conclusions:
The current review found that people with mental illness are significantly associated with increased BPV regardless of age. Since mental illness can contribute to impaired autonomic function (HRV, BPV), early therapeutic intervention in mental illness can prevent diseases associated with autonomic dysregulation and reduce the likelihood of negative cardiac outcomes. These findings may therefore have important implications for patients’ future physical health and well-being, highlighting the need for comprehensive cardiovascular risk reduction.
Comments
Scientists from the University of South Australia have discovered another reason why society should pay more attention to mental health: it is closely related to variations in blood pressure and heart rate.
A new study published in BioMedical Engineering establishes a link between mental illness and highly fluctuating blood pressure, which can lead to cardiovascular disease and organ damage.
UniSA researcher Dr Renly Lim and colleagues from universities in Malaysia say there is clear evidence that mental illness interferes with the body’s autonomic functions, including blood pressure, heart rate, temperature and breathing.
“We reviewed 12 studies on people with anxiety, depression and panic disorders and found that, regardless of age, mental illness is significantly associated with greater variations in blood pressure throughout the day,” says Dr. Lim.
“We also found that for people with mental illness, their heart rate does not adapt to external stressors as it should.
“Contrary to what many people think, a healthy heart is not one that beats like a metronome. Instead, it must be adjusted to withstand environmental and psychological challenges. A constantly changing heart rate is actually a sign of good health .”
Reduced heart rate variation (HRV) is common in people with mental illness and indicates that the body’s response to stress is poor, exacerbating the negative effects of chronic stress.
Unlike a person’s heart rate (how many times a heart beats in a minute), which is usually constant, HRV is more complex and is the time between two heartbeats, which should change depending on external stressors.
“What we are looking for is not a constantly changing heart rate, but a high variation in heart rate. This is achieved through a healthy diet, exercise, low stress and good mental health.”
Low HRV occurs when a person’s body is in fight or flight mode , is easily stressed, and is common in people with chronic illnesses, including cardiovascular and mental health problems.
While large variations in blood pressure (BPV) during the day are not ideal, at night the systolic pressure should decrease by 10 to 20 percent to allow the heart to rest. Researchers found that in people with mental health problems, their blood pressure does not drop enough at night.
Reduced immersion (less than 10 percent) can be caused by many factors, including autonomic dysfunction, poor sleep quality, and disrupted circadian rhythms that regulate the sleep-wake cycle.
“The takeaway from this study is that we need to pay more attention to the physical impacts of mental illness,” says Dr. Lim.
“It is a significant global burden, affecting between 11 and 18 percent (one billion) of people worldwide. Since mental illness can contribute to impaired heart and blood pressure regulation, early therapeutic intervention is essential.”
