Anxiety and hypertension in young and middle-aged adults: a longitudinal cohort study

Background: There is a significant prevalence of hypertension among younger and middle-aged adults. Anxiety is a potential psychosocial risk factor, but there is mixed evidence regarding this association in younger adults. Methods: This study analyzed data from the National Longitudinal Study of Adolescent to Adult Health, focusing on Waves 4 and 5, to explore the relationship between anxiety and incident hypertension in 9283 participants. Incident hypertension was classified first with objective blood pressure measures and antihypertensive medication use and, secondly, including self-reported diagnosis. Anxiety was identified in Waves 4 and 5, including age at diagnosis. Analyses used multivariable logistic regression and Cox proportional hazards models with anxiety treated as a time-dependent predictor. Results: The average age was similar to 29 at Wave 4 and similar to 37 at Wave 5. Results showed mixed evidence, with no significant association between prior anxiety and objectively measured hypertension. However, including self-reported hypertension, a prior diagnosis of anxiety was associated with incident hypertension (aOR = 0.76, 95% CI: 0.63-0.92). Time-to-event analyses further supported this inverse relationship. Conclusion: This study found some evidence suggesting an inverse relationship between anxiety and incident hypertension in young to middle-aged adults, warranting further longitudinal research into the complex relationship between mental and cardiovascular health.