Association between symptoms of anxiety and depression and blood pressure variability in older outpatients

Introduction: 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. Aim: 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). Methods: 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. Results: 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). Conclusions: 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.