4 ΔSBP ΔDBP ΔMAP ΔHR ΔSBP ΔDBP ΔMAP ΔHR R2 0.14 0.16 0.15 0.14 R2 0.12 0.12 0.20 0.02 International Journal of Hypertension Table 3: Parsimonious linear regression models for cardiovascular reactivity to cold pressor test. df 1,46 1,46 1,46 1,46 df 1,49 1,49 1,49 1,49 F 7.35 8.63 7.94 7.48 F 6.39 6.69 11.67 1.08 P 0.009 0.005 0.007 0.009 P 0.015 0.013 0.001 0.303 Variables State anxiety State anxiety State anxiety State anxiety Variables State anxiety State anxiety State anxiety State anxiety β 8.72 7.36 7.00 6.28 β 7.33 4.59 5.60 2.02 t 2.71 2.94 2.82 2.73 t 2.53 2.59 3.42 1.04 P 0.009 0.005 0.007 0.009 P 0.015 0.013 0.001 0.303 The models explained 14% of the variance for SBP, 16% for DBP, 15% for MAP, and 14% for HR. Table 4: Parsimonious linear regression models for cardiovascular reactivity to anger recall. The models explained 12% of the variance for SBP, 12% for DBP, 20% for MAP, and 2% for HR. stress tests (Pearson’s r = 0.33; P < 0.02 and r = 0.38; P < 0.01, resp.). The following variables were evaluated in the stepwise procedure: state anxiety, trait anxiety, resting cardiovascular measures, body mass index, and age. The variable selection results of the stepwise algorithm suggested the use of state anxiety for a parsimonious model of both cold pressor car- diovascular reactivity as well as anger recall cardiovascular reactivity. Our next step was to evaluate regression models to pre- dict cardiovascular reactivity with state anxiety as the in- dependent variable. The model for predicting the CP increase in SBP (see Table 3) had an r2 of 0.14 and state anxiety as a signiﬁcant parameter (P = 0.009). State anxiety was also a signiﬁcant independent variable (P = 0.005) in the model of the CP change in DBP (r2 = 0.16). Similar results were found with the model for predicting the change in cardiovascular reactivity for the AR stressor as shown in Table 4. State anxiety was a signiﬁcant parameter for the change in SBP (P = 0.015, r2 = 0.12) and DBP (P = 0.013, r2 = 0.12). Each model was scrutinized to verify adherence to the assumptions of regression modeling (linear relationship between independent variables and dependent variables, ho- moscedasticity of the errors, and errors are independent and normally distributed). Plots of residuals of each model against the predicted values were checked. Shapiro-Wilke statistics did not reject the hypothesis of normal distribution of the residuals. 5. Discussion This study investigated whether anxiety diﬀerentially aﬀects cardiovascular reactivity to cold pressor and anger recall stress tests in a sample of young, healthy, community dwell- ing African American adults, a population prone to develop cardiovascular disease. Importantly, we show that the state (at the moment) anxiety was signiﬁcantly associated SBP and DBP responses to both cold pressor and anger recall laboratory stress tests in this population. In contrast to blood pressure, state anxiety diﬀerentially predicted HR response to CP but not AR. On the other hand, chronic (trait) anxiety was not a signiﬁcant predictor of reactivity in our statistical models. We interpret these results to mean that the state of anxiety at the time of the stressor must be considered when assessing cardiovascular reactivity to laboratory stress tests. Failure to consider state anxiety as a confounder of reactivity responses may lead to misidentifying some individuals as hyperresponders when compared to others. Misidentiﬁca- tion of individuals may contribute in part to the inconsistent ﬁndings of increased reactivity in African Americans and to the inconsistent prediction of hypertension in those with increased vascular reactivity. Alternatively, these results can be interpreted to mean that the interaction of state anxiety and cardiovascular reactivity may be important determinants of hypertension development in African Americans. Anxiety, chronic anxiety in particular, has been linked to the development of disease [36]. Contrary to what would be expected, chronic anxiety has been shown to be negatively associated with cardiovascular reactivity [15]. Although chronic anxiety and cardiovascular reactivity associations have been studied, few studies have investigated the role of state anxiety in determining blood pressure response to stress. State anxiety is important in predicting the DBP “white coat” response and is eﬀective in predicting ambu- latory evening systolic blood pressure in young black males [24]. Studies that have investigated the eﬀect of state anxiety on reactivity did not include African Americans [16, 37]. Our study provides evidence that young healthy African Americans who are anxious prior to the stress tests are likely to have higher blood pressure responses to the stress. Thus, variability in hyperresponsiveness response to laboratory stress tests in African Americans may be due in part to a failure to consider state anxiety as a confounder. Although many studies have shown that enhanced car- diovascular reactivity predicts hypertension development and other cardiovascular events [1–5], there are several stud- ies that failed to show any relationship between reactivity to stress and hypertension development [1, 6–12]. The reason