Abstract P339: Association Between Self-monitored Blood Pressure, Heart Rate, And Anxiety Symptoms In A Digital Heart Health Self-management Program

Abstract

Introduction: Anxiety is a risk factor for hypertension and other cardiovascular (CV) diseases, and this relationship may be mediated by direct biological effects and/or indirectly via behaviors. We aimed to study the association between change in blood pressure (BP), heart rate (HR), and anxiety symptom severity among participants enrolled in a smartphone-based CV risk self-management program. Methods: We retrospectively studied participants with hypertension engaging with digital coaching focused on non-pharmacological lifestyle interventions, and who completed at least two generalized anxiety disorder (GAD-7) questionnaires between April 2020 and March 2023. Change in GAD-7 score was correlated with change in systolic BP, diastolic BP, and HR, controlling for age, gender, number of GAD-7 self-assessments, and initial GAD-7 score. Median BP and HR for the week of each GAD-7 self-assessment was used, and all change scores were converted to rate of change per day to control for variable time between scores. Results: A total of 5079 (age 58 ± 0.15y, 58% female) participants were included. Median days between GAD-7 scores was 148 (IQR 47-330). At baseline, mean GAD-7 was 7 (± 0.001), mean BP was 135/83 (± 0.28/0.18) mm Hg, and mean HR was 75 (± 0.22) bpm. Severe anxiety (GAD-7 > 14) was reported in 605 (12%) participants, and 34.3% were stage 2 hypertensive. By follow up, most of those with severe anxiety at baseline (430, 71%) showed reduced GAD-7 score (mean change = -4.5 ± 0.23). Both SBP (β = 0.03 ± 0.008, t = 3.6) and HR (β = 0.02 ± 0.009, t = 2.3) rate of change were associated with GAD-7 change such that the more participants reduced SBP or HR, the greater the reduction in anxiety symptoms. Initial GAD-7 scores were negatively associated with GAD change (β = -0.2 ± 0.016, t = -12.3). No other variable was statistically significant (all ps > 0.15). Conclusion: In a smartphone-based CV risk self-management program, reduction in systolic BP and HR is associated with improvement in anxiety symptoms, suggesting that digital coaching targeting CV risk factors has the potential to also improve mental health.