Relationship between mental health disorders and the circadian rhythm of ambulatory blood pressure in patients with essential hypertension

Objective

To investigate the impact of mental health disorders (MHD) on the circadian rhythm of ambulatory blood pressure (BP) in civilian patients with essential hypertension (EH) in the context of the armed conflict in Ukraine.

Design and methods

A total of 208 treated EH patients (mean age 50.4 ± 2.4 years) were screened for MHD. Ninety-four patients were diagnosed with MHD. Clinical characteristics and laboratory parameters were assessed. Anxiety and depression were evaluated using the HADS, GAD-7, and PHQ-9 scales.

Results

After treatment adjustment, 60.6% of patients (n = 57) failed to achieve target mean daytime systolic (SBP) and/or diastolic blood pressure (DBP) levels, while 37.2% (n = 35) did not achieve target mean nighttime SBP and/or DBP levels. Abnormal circadian BP patterns were detected in 58.6% of patients. The non-dipper pattern was observed in 36.2%, the night-peaker pattern in 4.3%, and the over-dipper pattern in 18.1%. Increased BP variability was found in 38.3% of patients during the daytime and in 35.1% during the nighttime.

Significant correlations were found between circulating endothelial progenitor cell (EPC; CD45−/CD34+) levels and daytime SBP variability (r = 0.481, P = 0.01) as well as daytime DBP variability (r = 0.591, P = 0.001). EPC levels were also positively correlated with the severity of anxiety and depression symptoms (r = 0.396, P = 0.001). Plasma cortisol concentration showed a positive correlation with mean HADS scores (r = 0.284, P = 0.04) and PHQ-9 scores (r = 0.405, P = 0.01). Plasma norepinephrine levels were associated with PHQ-9 scores (r = 0.309, P = 0.04). Epinephrine concentration correlated with 24-hour SBP (r = 0.395, P = 0.04) and daytime SBP (r = 0.344, P = 0.04).

Conclusions

Mental health disorders in patients with EH under conditions of chronic stress are associated with neuroendocrine alterations contributing to disturbances in the circadian BP profile, elevated BP levels, and increased BP variability. Concurrently, bone marrow activation stimulates the release of EPC as a compensatory mechanism to restore endothelial integrity.