PANIC DISORDER AS A DETERMINANT OF HYPERTENSION DEVELOPMENT: AUTONOMIC, NEUROBIOLOGICAL, AND BIOPSYCHOSOCIAL MECHANISMS LINKING ACUTE PANIC TO CHRONIC CARDIOVASCULAR DISEASE – REVIEW

Iga Maria Kwiecień; Karolina Bartoszewska; Wojciech Ługowski; Julia Ługowska; Jakub Komorowski - Roszkiewicz; Karol Marcyś; Julia Głowacz; Anna Nagrodzka; Weronika Matwiejuk

doi:10.31435/ijitss.2(50).2026.5072

Authors

Iga Maria Kwiecień Uniwersyteckie Centrum Kliniczne WUM, ul. Banacha 1a, 02-097 Warszawa, Poland https://orcid.org/0009-0008-8391-1366
Karolina Bartoszewska Uniwersyteckie Centrum Kliniczne WUM, ul. Banacha 1a, 02-097 Warszawa, Poland https://orcid.org/0009-0002-4637-4529
Wojciech Ługowski Szpital Praski p.w. Przemienienia Pańskiego, al. „Solidarności” 67, 03-401 Warszawa, Poland https://orcid.org/0009-0001-1288-4654
Julia Ługowska Samodzielny Publiczny Specjalistyczny Szpital Zachodni im. św. Jana Pawła II, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland https://orcid.org/0009-0005-4786-7159
Jakub Komorowski - Roszkiewicz Warszawski Szpital Południowy, Pileckiego 99, 02-781 Warszawa, Poland https://orcid.org/0009-0006-7570-0898
Karol Marcyś Faculty of Medicine, Medical University of Warsaw, Poland https://orcid.org/0009-0008-3767-761X
Julia Głowacz Uniwersytet Medyczny w Lublinie, Al. Racławickie 1, 20-059 Lublin, Poland https://orcid.org/0009-0000-3564-703X
Anna Nagrodzka Faculty of Medicine, Uniwersytet Kardynała Wyszyńskiego, Warsaw, Poland https://orcid.org/0009-0004-7952-1120
Weronika Matwiejuk Faculty of Medicine, Gdański Uniwersytet Medyczny, Poland https://orcid.org/0009-0006-2261-7871

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5072

Keywords:

Panic Disorder, Hypertension, Sympathetic Nervous System, Blood Pressure Variability, Allostatic Load, Biopsychosocial Model

Abstract

Hypertension remains one of the leading global causes of cardiovascular morbidity and mortality. While traditional biomedical risk factors account for substantial risk, increasing evidence suggests that psychological and neurobiological mechanisms contribute significantly to long-term blood pressure regulation. Panic disorder, characterised by recurrent episodes of intense autonomic activation, may represent an under-recognised determinant of sustained hypertension development. This review synthesises epidemiological, autonomic, neurophysiological, inflammatory, and biopsychosocial evidence linking panic disorder with hypertension. Converging evidence indicates altered sympathetic firing patterns, enhanced baroreflex gain, increased blood pressure variability, recurrent hypertensive surges, endothelial dysfunction, and cumulative allostatic load. Longitudinal data demonstrate elevated risk of incident hypertension among individuals with panic disorder independent of conventional cardiovascular risk factors. Integrating mental health assessment into cardiovascular prevention strategies may provide an innovative interdisciplinary approach to reducing global disease burden.

References

Bladowski, M., Mazur, G., & Małyszczak, K. (2021). The relationship between panic disorder and hypertension: A review of literature. Psychiatria Polska, 55(2), 345–361. https://doi.org/10.12740/PP/116570

Davies, S. J. C., Ghahramani, P., Jackson, P. R., Hippisley-Cox, J., Yeo, W. W., & Ramsay, L. E. (1997). Panic disorder, anxiety and depression in resistant hypertension: A case-control study. Journal of Hypertension, 15(9), 1077–1082. https://doi.org/10.1097/00004872-199715100-00005

Esler, M. (2008a). Chronic mental stress is a cause of essential hypertension: Presence of biological markers of stress. Clinical and Experimental Pharmacology and Physiology, 35(4), 498–502. https://doi.org/10.1111/j.1440-1681.2008.04904.x

Esler, M. (2008b). Human sympathetic nerve biology: Recent advances. Annals of the New York Academy of Sciences, 1148, 330–357. https://doi.org/10.1111/j.1749-6632.2008.03620.x

Esler, M. (2021). Reflections on the past four decades of mental stress research in autonomic cardiology. Clinical Autonomic Research, 31(1), 11–14. https://doi.org/10.1007/s10286-020-00761-7

Guan, X., & Cao, P. (2024). Brain mechanisms underlying panic attack and panic disorder. Neuroscience Bulletin, 40(6), 795–814. https://doi.org/10.1007/s12264-023-01088-9

Lambert, E. A., Thompson, J., Schlaich, M., Laude, D., Elghozi, J.-L., Esler, M. D., & Lambert, G. W. (2002). Sympathetic and cardiac baroreflex function in panic disorder. Journal of Hypertension, 20(12), 2445–2451. https://doi.org/10.1097/00004872-200212000-00025

Lambert, E. A., Schlaich, M. P., Dawood, T., Sari, C. I., Chopra, R., Barton, D. A., Kaye, D. M., Elam, M., Esler, M. D., & Lambert, G. W. (2011). Single-unit muscle sympathetic nervous activity and its relation to cardiac noradrenaline spillover. The Journal of Physiology, 589(10), 2597–2605. https://doi.org/10.1113/jphysiol.2011.205351

Macefield, V. G., & Wallin, B. G. (2018). Physiological and pathophysiological firing properties of single postganglionic sympathetic neurons in humans. Journal of Neurophysiology, 119(3), 944–956. https://doi.org/10.1152/jn.00674.2017

Pickering, T. G., & Clemow, L. (2008). Paroxysmal hypertension: The role of stress and psychological factors. Journal of Clinical Hypertension, 10(7), 575–581. https://doi.org/10.1111/j.1751-7176.2008.00078.x

Stein, D. J., Aguilar-Gaxiola, S., Alonso, J., Bruffaerts, R., de Jonge, P., Liu, Z., Scott, K. M., Viana, M. C., Al-Hamzawi, A., Angermeyer, M., Benjet, C., Bromet, E., de Girolamo, G., Demyttenaere, K., Florescu, S., Gureje, O., Haro, J. M., Hinkov, H., Karam, E. G., ... Kessler, R. C. (2014). Associations between mental disorders and subsequent onset of hypertension. General Hospital Psychiatry, 36(2), 142–149. https://doi.org/10.1016/j.genhosppsych.2013.11.002