Abstract
INTRODUCTION: Hypertension is a persistent global health issue, with psychological factors like stress, anxiety, and depression increasingly studied as potential contributors. However, their independent associations with hypertension remain unclear. OBJECTIVE: To examine the relationship between stress (using self-reported irritability as a proxy), anxiety, and depression with both the prevalence and severity of hypertension in a nationally representative adult population. METHODS: A cross-sectional analysis was conducted using publicly available data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey conducted by the Centers for Disease Control and Prevention (CDC). The study included 18,891 adults aged 18 and older. Hypertension was defined by self-reported medical diagnosis. Psychological variables included depression and anxiety scores, with stress proxied by reported irritability. Covariates included age, gender, race/ethnicity, physical activity, and BMI. Due to missing data, multiple imputation by chained equations (MICE) was applied. Multivariable logistic regression was used to assess associations. RESULTS: After adjustment, stress was significantly linked to higher odds of hypertension (β = 0.30, p < 0.03), while anxiety and depression were not. Older age, higher body mass index (BMI), and physical inactivity were also significant risk factors. Non-Hispanic Black and White participants had greater odds of hypertension compared to Mexican Americans. CONCLUSION: Stress was independently associated with hypertension, emphasizing the relevance of emotional strain in cardiovascular risk. Anxiety and depression showed no significant association. Findings support the inclusion of stress assessment in hypertension screening, though results are limited by the study's cross-sectional design and reliance on imputed data.