Factors associated with anxiety, depression, and cognitive impairment in individuals with hypertension: a cross-sectional study based on a Chinese population

Objective To investigate factors associated with anxiety, depressive symptoms, and cognitive impairment in individuals with hypertension. Methods A multicenter, large-sample cross-sectional study was conducted on 1,915 essential hypertension patients from multiple hospitals in Shandong Province (May 2022–July 2024). They were divided into four groups by Mini-Mental State Examination, Hamilton Anxiety and Depression Scales: hypertension alone ( n = 1,350), with cognitive impairment ( n = 191), with anxiety/depression ( n = 309), and with all three conditions ( n = 65). Demographics, clinical indices, lifestyle, sleep quality, and treatment information were collected. Univariate analysis, binary logistic regression, and ROC curves were used to examine these factors. Results Independent risk factors for hypertension patients with anxiety/depression included waist circumference (OR=1.06), heart rate (1.02), education level, alcohol cessation (3.1), usual systolic blood pressure (1.02) and poor sleep; protective factors included age (0.94), height (0.96), occasional drinking (0.25), hypertension family history (0.15) and lower LDL-C (0.73). For hypertension patients with all three conditions, risk factors were waist circumference (1.07) and poor sleep. Lower LDL-C (0.62) was a protective factor. ROC curves showed good discriminative capacity (AUC=0.895, 0.887). Conclusion Among individuals with hypertension, comorbid anxiety, depression, and cognitive impairment are associated with poorer sleep quality and elevated waist circumference. Lower LDL-C and appropriate lipid management may have protective effects.