This article comprehensively explores the relationship between anxiety and hypertensive disorders of pregnancy (HDP), covering epidemiology, potential mechanisms, and management strategies. HDP is the second leading cause of maternal and perinatal morbidity and mortality, encompassing subtypes such as gestational hypertension, preeclampsia, and eclampsia. Research indicates that anxiety is closely associated with the occurrence of HDP, potentially influencing blood pressure regulation and vascular function through neuroendocrine, inflammatory, genetic, and gut microbiota effects. Epidemiological data show that anxiety is prevalent during pregnancy and is linked to an increased risk of HDP. Biological mechanism studies reveal that anxiety can increase the risk of HDP by activating the hypothalamic-pituitary-adrenal axis, promoting inflammation, and affecting gut microbiota. In terms of treatment and management, psychological interventions (such as relaxation training, yoga, and mindfulness meditation) and pharmacological treatments (such as labetalol and nifedipine) play important roles in alleviating anxiety and improving the prognosis of HDP. Additionally, multidisciplinary collaboration and long-term postpartum follow-up are crucial for reducing the long-term risk of cardiovascular diseases. Despite significant progress in research on anxiety and HDP, many issues still require further exploration, including in-depth mechanism studies, optimization of clinical interventions, improvement of multidisciplinary collaboration models, long-term follow-up studies, and the impact of cultural and social factors.