Understanding the Psychological Factors that Impact Hypertension: A Systematic Review

The development and management of hypertension strongly depends on psychological elements which include depression, anxiety together with stress and psychosocial support. This review analysed psychological elements that affect hypertension development from the year 2014 to 2025. The research identified 106 studies through a systematic database search of MEDLINE, Embase, PsycINFO, Scopus and CINAHL. Due to diverse methodologies, the research employed a narrative synthesis approach. The risk of bias was assessed using the Cochrane Risk of Bias Tool, Newcastle–Ottawa Scale, Domain-Based Approach, CASP, and ROB-MR Instrument. Results indicated that both depression and anxiety increased the risk of developing hypertension and decreased adherence to treatment. In contrast, mindfulness-based interventions showed potential blood pressure lowering effects, although evidence for long term outcomes is limited. People with strong psychosocial support networks and higher levels of life satisfaction had better medication adherence and lower stress levels. However, the current evidence base shows that most studies originate from high-income countries, with low- and middle-income countries having limited evidence and most low-income settings contributing only one or two studies, with no more than four studies per country. The results support the need to integrate physical and mental health care models in the management of hypertension. To enhance understanding of the psychological aspects of hypertension, future research should include underrepresented regions and implement both longitudinal and qualitative methods.