The Impact of Trait Anxiety on Blood Pressure Variability and Target Organ Damage in Hypertensive Patients: A Cross-Sectional Study.

Background: Hypertension is a leading global cardiovascular risk factor. Blood pressure variability (BPV) and target organ damage (TOD) are strong predictors of adverse cardiovascular outcomes. Trait anxiety is associated with sympathetic nervous system hyperactivity and hypothalamic-pituitary-adrenal axis dysregulation, both of which may elevate BPV and promote TOD. However, evidence linking trait anxiety to 24-hour BPV and subclinical TOD in hypertension remains limited. This study aimed to investigate the independent association of trait anxiety with BPV and TOD in hypertensive patients, and to clarify its clinical significance and novelty relative to existing literature. Objective: This study aimed to investigate the relationship between trait anxiety and both target organ damage (TOD) and blood pressure variability (BPV) in hypertensive patients. Methods: A cross-sectional observational study was conducted including 285 hypertensive patients. Trait anxiety was measured using the State-Trait Anxiety Inventory (STAI). Ambulatory blood pressure monitoring (ABPM) was performed to assess 24-hour BPV. Cardiac-ankle vascular index (CAVI) and left ventricular mass index (LVMI) were measured on the same day as ABPM after 15 minutes of supine rest to evaluate vascular and cardiac TOD. Multivariate regression and partial correlation analyses were used to examine independent associations. Results: Among the 285 hypertensive patients, 142 were classified into the low trait anxiety group and 143 into the high trait anxiety group, with well-balanced baseline characteristics between groups. Compared with the low anxiety group, patients with high trait anxiety exhibited significantly higher 24-hour systolic and diastolic blood pressure variability (BPV), as well as elevated left ventricular mass index (LVMI) and cardio-ankle vascular index (CAVI) (all P<0.05). Further partial correlation and multivariate regression analyses demonstrated that trait anxiety was independently and strongly associated with 24-hour average real variability (ARV) of systolic blood pressure, 24-hour ARV of diastolic blood pressure, LVMI, and CAVI (all P<0.001). These associations remained statistically significant after adjustment for age, gender, BMI, hypertension duration, medication use, and laboratory confounders. Conclusion: Trait anxiety is independently associated with increased 24-hour BPV and early TOD in hypertensive patients. As a modifiable psychological risk factor, trait anxiety may contribute to cardiovascular remodeling beyond mean blood pressure levels. Routine screening and anxiety intervention may help improve BPV control and reduce TOD progression. These findings provide new evidence for integrated psychological and cardiovascular management of hypertension.