Comorbidity of Anxiety and Depression With Hypertension Among Young Adults in the United States: A Systematic Review of Bidirectional Associations and Implications for Blood Pressure Control.

Hypertension is a significant risk factor for cardiovascular diseases, while anxiety and depression are highly prevalent mental health disorders that may influence the development and management of hypertension. The bidirectional associations between these conditions remain understudied, particularly among adults in the United States. Understanding the interplay of mental health and hypertension is critical for improving clinical and public health interventions. This systematic review aims to examine the prevalence and bidirectional associations between anxiety, depression, and hypertension among US adults; identify clinical, behavioral, and sociodemographic factors influencing comorbidity; and explore implications for hypertension management. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across multiple databases, including PsycINFO, Scopus, PubMed, Web of Science, ScienceDirect, and Google Scholar, covering literature from 2015 to 2024. Eligible studies included cross-sectional, cohort, and case-control designs focusing on US adults (≥18 years) and examining the association between anxiety, depression, and hypertension. Data extraction covered study characteristics, diagnostic criteria, statistical findings, and relevant confounders. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Eight studies met the inclusion criteria, comprising six cross-sectional and two cohort studies. Anxiety and depression were significantly associated with increased hypertension risk, with stronger effects observed among low-income populations, women, and minority groups. Cohort studies indicated that depression contributed to hypertension incidence via inflammatory and autonomic dysfunction pathways, while cross-sectional studies highlighted that hypertension itself exacerbated psychological distress, leading to a cyclical comorbid relationship. The review also found that individuals with comorbid anxiety or depression had poorer hypertension control and lower adherence to antihypertensive treatment. The findings underscore the need for integrated care approaches that address both mental health and hypertension, particularly in vulnerable populations. Routine mental health screenings should be incorporated into hypertension management strategies to improve adherence and outcomes. Future longitudinal research should explore causal mechanisms and assess intervention effectiveness in mitigating the adverse effects of comorbidity.