Anxiety and hypertensive disorders of pregnancy: Epidemiology, mechanisms, and management strategies

Table 1 Anxiety and hypertensive disorders of pregnancy: Relationship, mechanisms, and management

Category	Details
Epidemiology	Anxiety is significantly associated with HDP, increasing the risk of HDP (OR = 1.324), preeclampsia (OR = 1.522), and eclampsia (OR = 1.813)
	Global prevalence of HDP: 6.3% in the United States, 8.0% in China
	Anxiety prevalence: 13.6% in the United States, 16% in China
	Anxiety rates among immigrant women from low-income countries can reach up to 31%
Potential mechanisms	Neuroendocrine mechanisms: Anxiety activates the HPA axis, increasing cortisol levels and enhancing renin-angiotensin system activity, leading to vasoconstriction and elevated blood pressure
	Inflammatory mechanisms: Anxiety promotes the release of proinflammatory cytokines (e.g., TNF-α, IL-6, IL-17), impairing vascular endothelial function and promoting oxidative stress
	Genetic and epigenetic mechanisms: HDP-associated genetic variants (e.g., angiotensinogen gene mutations) increase cardiovascular risk
	Gut microbiota and metabolic regulation: Anxiety-induced gut microbiota dysbiosis affects blood pressure regulation through the "gut-brain-vascular axis"
	Autonomic nervous system and hemodynamic changes: Anxiety-induced sympathetic overactivation reduces heart rate variability and increases vascular resistance
Treatment and management	Psychological Interventions: Relaxation training, yoga, and mindfulness meditation significantly reduce blood pressure and stress
	Pharmacological treatment: First-line drugs like labetalol and nifedipine are used for HDP management; SNRIs may increase HDP risk
	Multidisciplinary collaboration: Obstetricians, psychologists, nutritionists, and other specialists collaborate to optimize patient management
Long-term risks	HDP is associated with increased long-term risks of cardiovascular disease, chronic kidney disease, and metabolic syndrome
	Anxiety exacerbates these risks through persistent activation of inflammatory pathways and endothelial dysfunction
Future research directions	Mechanistic Studies: Further explore neuroendocrine, inflammatory, and autonomic nervous system pathways linking anxiety and HDP
	Optimization of Interventions: Validate the effectiveness and safety of psychological and pharmacological interventions through RCTs
	Multidisciplinary collaboration models: Improve integration of resources from obstetrics, psychology, and nutrition for personalized treatment plans
	Long-term follow-up studies: Assess the long-term health impacts of anxiety and HDP on mothers and infants
	Cultural and social factors: Examine the role of sociocultural stressors and support systems in anxiety and HDP

HDP: Hypertensive disorders of pregnancy; HPA: Hypothalamic-pituitary-adrenal; IL: Interleukin; OR: Odds ratio; RCTs: Randomized clinical trials; SNRIs: Serotonin-norepinephrine reuptake inhibitors; TNF-α: Tumor necrosis factor alpha.