Association Between Symptoms of Anxiety and Depression and Blood Pressure Variability in Older Outpatients

Blood pressure variability (BPV) predicts cardiovascular risk beyond average BP, but evidence on the role of anxiety/depression on BPV in older adults is limited.

To evaluate the association of anxiety and depressive symptoms with short-term BPV and white-coat effect (WCE) in older outpatients undergoing ambulatory blood pressure monitoring (ABPM).

Cross-sectional multicenter study of outpatients aged ≥ 65 years undergoing 24-h ABPM across Italian geriatric centers. Anxiety and depressive symptoms were assessed with GAD-7, STAI-Y1/Y2 and GDS-15. Short-term BPV was quantified by daytime systolic average real variability (ARV). The office-daytime BP difference was calculated (ΔSBP and ΔDBP), and WCE was defined categorically as ΔSBP ≥ 20 mmHg and/or ΔDBP ≥ 10 mmHg. Multivariable models were adjusted for clinical and pharmacological confounders.

Among 235 outpatients (median age 76.4 years, 60.0% female), anxiety prevalence varied widely by scale (GAD-7: 34.9%; STAI-Y1: 74.0%; STAI-Y2: 73.2%), while depressive symptoms were present in 28.5%. ARV did not significantly differ in patients screening positive or negative for anxiety (GAD-7: 16.4 vs 15.5 mmHg, p = 0.349; STAI-Y1: 16.2 vs 14.9 mmHg, p = 0.214; STAI-Y2: 16.2 vs 14.8 mmHg, p = 0.160), or between those with and without depressive symptoms (15.9 vs 15.8 mmHg, p = 0.902); also, after adjustment for potential confounders. WCE prevalence was 40.9% and was higher in participants screening negative for depressive symptoms (39.2% vs 23.9%, p = 0.039). ΔSBP tended to be higher in participants screening negative for anxiety (GAD-7: 7.6 vs 3.3 mmHg, p = 0.095) and depressive symptoms (GDS-15: 7.6 vs 2.6 mmHg, p = 0.065).

Anxiety and depressive symptoms were not independently associated with short-term BPV in older outpatients. WCE/ΔSBP were generally higher, albeit non significantly, in participants without anxiety or depression. These findings suggest that psychological symptoms may contribute only modestly to short-term BP fluctuations in older adults.