Anxiety in Patients Seeking Emergency Care for Elevated Blood Pressure

Patients frequently seek care in the emergency department (ED) because of elevated blood pressure (BP). The majority have chronic hypertension rather than an acute hypertensive emergency. However, some may have comorbid anxiety, which is associated with increased cardiovascular risk and is a potentially modifiable factor. Our objective was to estimate the prevalence of clinically significant general and cardiac-specific anxiety in in this population.

We conducted a prospective cross-sectional, observational study on a convenience sample of adults with a chief complaint of elevated BP at one urban academic ED. We excluded pregnant or post-partum patients, patients on dialysis, and critically ill patients. General and cardiac-specific anxiety were assessed using the 7-item Generalized Anxiety Disorder (GAD-7) and Cardiac Anxiety Questionnaire (CAQ) instruments. Clinical characteristics and serious diagnoses from the index visit through 30 days were assessed by chart review. Continuous variables were summarized as mean (SD) or median (IQR), and categorical variables as proportions with 95% confidence intervals (Cis). Association between GAD-7 and CAQ raw scores was evaluated using Spearman’s rank correlation with bootstrap resampling.

A total of 105 patients were included. The average age was 63 years (IQR: 50, 74) and 58/105 (55%) were female. Most patients had concomitant somatic symptoms, most frequently headache (33%), chest pain (23%), and dizziness (21%). Seven patients were admitted from the ED; the remainder were discharged or walked out. No serious events occurred during index visits, though 3 patients had significant events within 30 days. Median GAD-7 score was 4 (IQR: 1, 10) with 26/99 (26.3%, 95% CI: 0.18, 0.36) patients having clinically significant anxiety at a threshold of GAD-7 ≥ 10. Mean CAQ was 1.78 (95% CI: 1.44, 2.39) with 25/47 (53.2%, 95% CI: 0.38, 0.68) patients having a score above the 90th percentile. GAD-7 and CAQ scores showed little association (ρ = 0.15, 95% CI: -0.14, 0.42).

A substantial proportion of patients presenting to the ED with elevated BP exhibited clinically significant anxiety. However, scores on the GAD-7 and CAQ demonstrated minimal association. More comprehensive studies are needed to better characterize anxiety in these patients and to identify appropriate screening instruments for use in this population.