2 due to the interaction of anxiety with acute stressors may explain the inconsistent reports of increased risk of hyper- tension with increased reactivity. This study sought to investigate whether (1) anxiety determined the blood pressure response to stress tests and (2) anxiety diﬀerentially inﬂuenced blood pressure response to anger recall and cold pressor stress tests in African Americans. We chose to study African Americans for several reasons: (1) this group is characterized as hyperresponsive to stress [7, 17–20], (2) several reports have failed to ﬁnd increased reactivity in this population [4, 8, 21–23], and (3) psychosocial factors, including anxiety, are signiﬁcantly associated with blood pressure in this population [24– 29]. We report that state (in the moment) anxiety was signiﬁcantly associated with blood pressure response to both stressors (anger recall and cold pressor stress tests) in this population. These results support the idea that identiﬁcation of hyperresponders to acute stress tests among African Americans must take into account anxiety levels before de- termining whether an individual has increased reactivity to acute stress and/or that anxiety may play an important role along with reactivity response in hypertension development. However, our results do not support the idea that anxiety diﬀerentially impacts reactivity response to psychological, psychophysical, and physical stressors. 2. Methods 2.1. Participants and Procedures. A sample of 179 (116 males, 63 females) participants of African descent were recruited to the study. All study procedures and materials were approved by and in compliance with the North Carolina Central University institutional review board. Eligibility criteria for entry were (1) be 18 to 65 years old (2) being a student or employee at North Carolina Central University or living in the surrounding regions of Durham, Orange and Wake counties, (3) having no diagnosed cardiovascular disease (self-reported), and (4) not taking any hypertensive medica- tion. These regions of Durham, Orange, and Wake counties make up the North Carolina Triangle region that is in the stroke belt (e.g., a geographic region with a higher occurrence of stroke) [30]. Of these 179, only 50 are reported in the current report; these were selected based on the type of mental stress used. The 50 participants reported here met the following criteria: (1) completed both the trait anxiety scale and the state anxiety scale, and (2) were between the ages of 18 and 40 years old. Study participants were scheduled at either 9 am or 1 pm for the three-hour study protocol. After receiving informed consent, trained staﬀ measured blood pressure by sphygmomanometer method with a GE Dinamap Pro 100 automatic model and a cuﬀ size appropriate for the body size. Each participant was allowed ﬁve minutes to sit quietly before taking the ﬁrst resting parameters. The Dinamap was set to assess systolic blood pressure (SBP) and diastolic blood pressure (DBP) at one- minute intervals for the resting measurements as well as during the two acute stressor tasks. State anxiety survey was administered prior to baseline blood pressure measurements. International Journal of Hypertension Following resting blood pressure and heart rate measure- ments, participants were administered the cold pressor test, consisting of submersion of the hand in ice cold water for three minutes followed by a ﬁve-minute recovery period. A psychological stressor, anger recall, was given only after blood pressures and heart rate returned to baseline resting values. Anger recall stress consisted of 5 minutes of contemplating an event that evoked anger, 5-minute discussion about the event, and 5-minute recovery period. Trait anxiety survey was administered following the completion of the anger recall stressor. Cardiovascular reactivity was calculated as the diﬀerence between the average baseline prestressor blood pressure and the average change in blood pressure over the 5-minute stress period. The study protocol consisted of state anxiety assessment, resting BP measurement, second resting BP measurement, cold pressor stressor, third resting BP measurement, anger recall stressor, trait anxiety assessment, recording medical history, body mass index measurement, and completing a demographics questionnaire. 2.2. Psychosocial Anxiety Measure. Anxiety was assessed us- ing the state-trait anxiety inventory [31]. State anxiety is deﬁned as an acute response to a threatening or challenging situation, while trait anxiety is deﬁned as a stable and en- during tendency to be anxious. Each subscale is a 20-item self-report inventory. Each item is rated on a four-point scale (1 = almost never, 4 = almost always). Items from each subscale are summed to create a total state anxiety score and a total Trait Anxiety score. Higher scores on the state anxiety subscale indicate greater anxiety at the present time; higher scores on the trait anxiety subscale indicate greater anxiety, in general. The state anxiety subscale has an alpha coeﬃcient of .87, and the trait anxiety has an alpha coeﬃcient of .88, indicating good (since .80 or greater) internal consistency in this sample. 3. Statistics Data analysis was performed using SAS 9.1.3 for Windows [32]. Scoring of the psychosocial scales Spielberger State Trait Anxiety Inventory utilized scoring protocols documented in prior research as indicated above and were conﬁrmed with factor analysis. Cronbach’s alpha values were conﬁrmed as reported above. Mean, standard deviation, standard error, median, and quartile calculations provide data reductions for SBP, DBP, and other clinical measures with multiple mea- surements. Regression models, goodness of ﬁt, multivariate parameter estimates, and conﬁdence intervals were evaluated for each stressors impact on SBP, and DBP. Two participants did not complete the cold pressor stressor; thus, the sample size is 48 for the cold pressor cardiovascular reactivity and 50 for the anger recall cardiovascular reactivity. 4. Results Table 1 shows the baseline characteristics of the study sample. The African American study samples are relatively young