Trait Anxiety and Blood Pressure Reactivity to Mental Stress

Abstract

Chronic stress is a prevalent issue among the general population, and has been associated with other comorbid pathologies. Despite its widespread impact, the effects of chronic stress on cardiovascular outcomes are not well understood. The purpose of this study was to assess the role trait anxiety might play in blood pressure reactivity at the onset of psychological stress, namely mental arithmetic. We hypothesized that increased trait anxiety levels would be correlated with an augmented blood pressure response at the onset of mental stress, indicating a higher cardiovascular reactivity to stress. Twenty‐four adults (10 men, 14 women; 22±1 years) were assessed during a three‐minute supine baseline followed by five minutes of psychological stress (mental arithmetic). Physiological variables measured included heart rate (HR; electrocardiogram) and blood pressure (sphygmomanometer and finger plethysmography). Trait anxiety was measured prior to the experiment (Spielberger Trait Anxiety Inventory). Average raw and standardized trait anxiety levels were 32±2 and 42±2, respectively. Due to low representation of severe anxiety, a tertile analysis was performed on both raw (n=8 per tertile) and standardized trait (T1: n=8, T2: n=7, T3: n=9) anxiety levels to assess blood pressure reactivity between the different severities represented in our sample population. Mental stress significantly (p<0.001) increased mean arterial pressure (MAP; Δ10±1 mmHg), systolic pressure (SAP; Δ10±2 mmHg), diastolic pressure (DAP; Δ9±1 mmHg), and heart rate (HR; Δ14±1 beats/min), but these increases were not significantly different between tertiles (p>0.05). However, during the first minute following the onset of mental stress, ANOVA analysis revealed a significant difference in the increase of MAP between tertiles (p=0.05). Following post hoc analysis, the first raw trait anxiety tertile exhibited a greater increase (p<0.05) in MAP (Δ8 ±2 mmHg) when compared to tertiles two (Δ2±2 mmHg) and three (Δ2±2 mmHg). Similarly, the first standard trait anxiety tertile showed a significantly greater increase (p<0.05) in MAP (Δ8±2 mmHg) when compared to both tertile two (Δ2±2 mmHg) and three (Δ2±2 mmHg). Contrary to our hypothesis, the results of this study indicate a decreased cardiovascular stress response and potential autonomic dysregulation in individuals with heightened stress levels. These results suggest the use of subjective anxiety questionnaires may be helpful during autonomic function testing to better account for the potential role of anxiety in cardiovascular reactivity.Support or Funding InformationNIH R01 AA‐024892 and NIH R21 HL098676