Can Anxiety Cause High Blood Pressure? Spikes vs Hypertension

Yes, in the short term. When you feel anxious, stress hormones make your heart beat faster and narrow your blood vessels, so your blood pressure rises for a while and then usually settles once the stress passes. Whether anxiety causes lasting high blood pressure is less certain, although large studies do link the two.

This is general information, not a diagnosis. For the other body symptoms anxiety can cause, see our guide to whether anxiety can cause physical symptoms.

Can anxiety raise your blood pressure right now?

Yes. Anxiety switches on the fight-or-flight response. The American Heart Association (AHA) explains that stress hormones make the heart beat faster and constrict blood vessels, and that these changes raise blood pressure temporarily. The AHA calls this situational stress: its effects are usually short-lived, and blood pressure returns to its pre-stress level once the stressful event is over.

So a reading taken while you are worried, rushed or mid-panic may be higher than your usual blood pressure. The AHA says a single high reading is not an immediate cause for alarm, and advises taking a second reading and writing both down (AHA: home blood pressure monitoring). A very high reading, or one with symptoms such as chest pain, still needs the action in “When to see a doctor” below, whatever you think the cause is.

Is a short-term spike the same as high blood pressure?

No. A spike is a brief rise that settles. High blood pressure, or hypertension, means your blood pressure stays high when it is measured on repeated occasions. NICE, which writes guidance for the NHS in England, describes persistent hypertension as high blood pressure at repeated clinical visits (NICE NG136). The NHS says that if a check suggests high blood pressure, you may be asked to use a home monitor for a few days, come back for another check, or wear a portable monitor that takes readings over 24 hours.

	Short-term spike	High blood pressure (hypertension)
What it is	A temporary rise during stress or anxiety	Blood pressure that stays high across repeated readings
How long it lasts	Usually settles once the stressful event is over	Persists between readings and over time
Symptoms	Often comes with anxiety symptoms, such as a racing heart	Usually none; many people have it without realizing
What to do	Rest and measure again later	See a doctor; lifestyle changes and sometimes medicine

Untreated hypertension strains the heart and blood vessels and raises the risk of heart attacks, strokes, heart failure and kidney disease, according to the NHS.

What counts as high blood pressure in the US and the UK?

The US and UK draw the line in different places, so the same number can be labeled differently. Blood pressure is written as two numbers in mmHg: the top (systolic) number and the bottom (diastolic) number.

Source	Category	Reading
AHA (US)	Normal	Below 120 and below 80
AHA (US)	Elevated	120 to 129 and below 80
AHA (US)	Stage 1 hypertension	130 to 139 or 80 to 89
AHA (US)	Stage 2 hypertension	140 or higher or 90 or higher
AHA (US)	Severe hypertension	Higher than 180 and/or higher than 120
NHS (UK)	High blood pressure, checked by a health professional	140/90 or higher
NHS (UK)	High blood pressure, checked at home	135/85 or higher

The US categories come from the AHA blood pressure chart and the UK thresholds from the NHS. So a reading of 134/84 is stage 1 for the AHA but below both NHS thresholds. The UK home threshold is lower because NICE treats home readings as 5 mmHg lower than clinic readings (NICE NG136). Only a doctor can confirm a diagnosis.

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What is the white-coat effect?

The white-coat effect is when your blood pressure reads higher in a clinic than it does at home or on a 24-hour monitor. NICE defines it as a gap of more than 20/10 mmHg between clinic readings and the average of home or daytime 24-hour readings at the time of diagnosis.

A clinic reading alone could therefore suggest hypertension when your everyday blood pressure is lower. That is one reason NICE confirms hypertension only when the clinic reading is 140/90 or higher and the home or daytime 24-hour average is 135/85 or higher. The reverse, masked hypertension, also happens: normal clinic readings but higher readings outside the clinic.

Anxiety is often assumed to cause the white-coat effect, but the evidence is mixed. A 2022 study of 544 people being treated for hypertension found no significant difference in anxiety scores between those with a white-coat effect and those without; sex, older age and the number of blood pressure medicines were linked to it instead (Xu et al., 2022). One study does not settle the question, but it is a reason not to write off a high clinic reading as “just nerves” without home readings to compare.

Do anxiety disorders raise the risk of hypertension?

Possibly. Large reviews find that people with anxiety are more likely to have or develop high blood pressure, but they show a link, not proof that anxiety is the cause.

• A 2015 meta-analysis pooled 8 prospective studies of 80,146 people and found anxiety was linked to a higher risk of developing hypertension (hazard ratio 1.55, about 55% higher). Across 13 cross-sectional studies of 151,389 people, the link was weaker (odds ratio 1.18) (Pan et al., 2015).
• A larger 2021 meta-analysis of 59 studies and just over 4 million participants found higher odds of hypertension in people with anxiety in both cross-sectional studies (odds ratio 1.37) and prospective studies (odds ratio 1.40) (Lim et al., 2021).

There are caveats. The studies in the 2015 review disagreed a lot with each other, and the 2021 review found its results depended on how hypertension was diagnosed. The 2021 authors say long-term data suggest anxiety may come first, but observational studies cannot rule out shared causes. The AHA says the link between long-term stress and blood pressure is still being studied, while noting that stress can feed risk factors such as a poor diet and drinking too much alcohol. The NHS lists feeling stressed over a long period among the things that raise your chances of high blood pressure.

The practical point: if you live with anxiety, do not assume every high reading is “just anxiety”. The NHS advises a check at a pharmacy or GP surgery if you think you may be at risk, or if you are 40 or over and have not been checked for more than 5 years. If you are unsure how much anxiety is affecting you, the GAD-7 anxiety self-check can help you describe it to a doctor.

How do you measure blood pressure properly at home?

Use a validated, automatic monitor with an upper-arm cuff, and measure when you are settled, not mid-worry. The AHA says wrist and finger monitors are not recommended because they give less reliable readings, and that a cuff of the wrong size gives an inaccurate result. A pharmacist can help you choose.

1. Prepare. Do not smoke, have caffeinated drinks or exercise in the 30 minutes before measuring, and empty your bladder first.
2. Rest. Sit quietly for at least five minutes beforehand. Do not talk or use your phone.
3. Sit correctly. Rest your arm on a flat surface at heart level. Put the cuff on bare skin, with its bottom edge just above the bend of your elbow.
4. Take two readings. Take two readings one minute apart and write both down.
5. Measure at the same time each day. To confirm a diagnosis, NICE recommends readings twice a day, ideally morning and evening, for at least 4 days and ideally 7, ignoring the first day and averaging the rest.
6. Check your monitor. Take it to your next appointment so a health professional can check you are using it correctly and that it matches the clinic equipment.

Steps 1 to 4 and step 6 follow the AHA’s advice. If you catch yourself checking again and again because you are worried, ask your doctor how often to measure, as the AHA also advises. The AHA lists controlled breathing among healthy ways to handle stress, and our guided breathing exercise can help you settle during the five-minute rest.

What helps with both anxiety and blood pressure?

Many of the same habits help both. For stress, the AHA suggests meditation, controlled breathing, regular exercise, at least 7 hours of sleep a night, limiting alcohol and not smoking; the NHS adds less salt and not too much caffeine for blood pressure. If anxiety itself is persistent, our anxiety guide covers treatments with good evidence, and panic attack vs anxiety attack explains sudden surges of fear.

When to see a doctor

See a doctor (your GP in the UK) if your home readings are often at or above the thresholds above, or if anxiety keeps coming back and affects daily life. Do not stop or change any blood pressure medicine based on home readings without talking to them first.

Get urgent advice (NHS 111 in the UK, or your doctor) if you often have headaches or blurred vision, or chest pain that comes and goes (NHS). If a home reading is higher than 180/120 and you have no symptoms, the AHA says to wait at least one minute and measure again; if it is still that high, contact your healthcare professional as soon as possible.

Call emergency services straight away if:

• your blood pressure is higher than 180/120 and you have chest pain, shortness of breath, back pain, numbness, weakness, a change in vision or difficulty speaking. The AHA calls this a hypertensive emergency and says not to wait to see whether it comes down on its own.
• you have sudden chest pain that does not go away (it can feel like squeezing, pressure, burning or indigestion), pain spreading to your arm, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness. The NHS says these can be a heart attack; do not drive yourself to A&E (the emergency room).

Do not assume chest pain or a very high reading is anxiety just because you have had anxiety before. In an emergency call 911 (US), 999 (UK) or 112 (EU). If anxiety comes with thoughts of self-harm or suicide, see our Get help now page for crisis lines.