Introduction:
Prior research on the association of anxiety with hypertension has yielded mixed results. Despite the high burden of both conditions in Hispanics/Latinos, little is known about their association in this population. This study examined the longitudinal relationship of trait anxiety with changes in BP and incidence of hypertension.
Hypothesis:
Higher trait anxiety at Visit 1 (V1) will be associated with greater increases in BP and incident hypertension over 6 years.
Methods:
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multi-center prospective community-based study of 16,415 diverse Hispanics/Latinos ages 18-74 at V1 (2008-11). Data included 11,048 participants with complete information on BP, trait anxiety, and other variables at V1 and V2 (2014-17). Trait anxiety was measured at V1 using the 10-item Spielberger Trait Anxiety Scale, which was dichotomized into low and high using a cut-point of 20 points, the top quartile in the HCHS/SOL cohort. BP was measured using a standardized protocol and validated automated device. Hypertension was defined as systolic BP ≥ 140 or diastolic BP ≥ 90 mm Hg or self-reported antihypertensive medication use. Linear regressions were used to examine the association of anxiety with BP change; to account for medication use, 9 mmHg and 6 mmHg were added to systolic and diastolic BP of treated participants, respectively. The association of anxiety with incident hypertension at V2 was examined using Poisson regression among those without hypertension at V1 (
N
= 7,878). Estimates were adjusted for complex survey design, sociodemographic factors, baseline BP, antidepressant/anxiolytic medication use, and health conditions.
Results:
Mean baseline age was 45.8 years and 60% were women. Mean change was 3.13 (
SE
= 15.67) in systolic and 0.21 (
SE
= 9.73) in diastolic BP. Individuals with high, compared to those with low, trait anxiety had greater increases in systolic (
B
= 1.10, 95% CI = 0.28-1.93,
p
= 0.009) and diastolic BP (
B
= 0.69, 95% CI = 0.11-1.27,
p
= 0.02) over 6 years, after adjusting for covariates. Individuals with high, relative to those with low, trait anxiety had an 18% higher risk of hypertension (RR = 1.18, 95% CI = 1.03-1.34,
p
= 0.012).
Conclusions:
Elevated trait anxiety is associated with small increases in BP over 6 years and an 18% higher risk of hypertension among diverse Hispanics/Latino adults. Research on the mechanisms underlying these relationships among Hispanics/Latinos is warranted to develop effective interventions to prevent and treat hypertension in this population.
Associations of Sleep Disordered Breathing and Insomnia with Incident Hypertension and Diabetes: The Hispanic Community Health Study/Study of Latinos
