Blood Pressure in Young Adults in Relation to Anxiety, Stress, and Cortisol: A Cross-Sectional Analysis of Mediation

Abstrak

Anxiety and perceived stress may be associated with blood pressure elevation in young adults. This study examined these associations and whether serum cortisol accounted for an indirect association. Methods: A cross-sectional study included 296 adults aged 18–40 years in Al-Najaf, Iraq. Blood pressure was measured using an automated monitor; anxiety and perceived stress were assessed using Arabic GAD-7 and PSS-10 questionnaires. Morning serum cortisol was assayed. Regression and PROCESS Model 4 mediation analyses used 5,000 bootstrap resamples. Results: Mean age was 31.4 ± 6.2 years; 57.8% were male. Mean SBP, DBP and MAP were 126.0 ± 16.3, 84.1 ± 12.2 and 98.1 ± 13.1 mmHg, respectively. The reported anxiety coefficients were 0.644 for SBP (p<0.001), 0.454 for DBP (p = 0.002) and 0.516 for MAP (p<0.001). Perceived stress was associated with SBP (β = 0.421, p = 0.008) and MAP (β = 0.387, p = 0.014). Cortisol correlated positively with SBP (r = 0.312) and MAP (r = 0.298), both p<0.001. All reported indirect-effect confidence intervals included zero. Conclusion: Anxiety and perceived stress were associated with higher blood pressure, but the analyses did not demonstrate mediation through a single morning cortisol measurement.