Psychosocial Factors and Risk of Hypertension: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 10/2003; 290(16):2138-48. DOI: 10.1001/jama.290.16.2138
Source: PubMed


CONTEXT: Although psychosocial factors are correlated, previous studies on risk factors for hypertension have typically examined psychosocial factors individually and have yielded inconsistent findings.
OBJECTIVE: To examine the role of psychosocial factors of time urgency/impatience (TUI), achievement striving/competitiveness (ASC), hostility, depression, and anxiety on long-term risk of hypertension.
DESIGN, SETTING, AND STUDY POPULATION: A population-based, prospective, observational study using participant data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. A total of 3308 black and white adults aged 18 to 30 years (when recruited in 1985 and 1986) from 4 US metropolitan areas and followed up through 2000 to 2001.
MAIN OUTCOME MEASURES: Fifteen-year cumulative incidence of hypertension (systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or taking antihypertensive medication).
RESULTS: The incidence of hypertension at year 15 was 15% from baseline and 13.6% from year 5. After adjusting for the same set of hypertension risk factors and each of the psychosocial factors of TUI, ASC, hostility, depression, and anxiety in 5 separate logistic regression models, higher TUI and hostility were significantly associated with risk of developing hypertension at 15-year follow-up for the total sample. Compared with the lowest score group, the adjusted odds ratio (OR) for TUI was 1.51 (95% confidence interval [CI], 1.12-2.03) for a score of 1; 1.47 (95% CI, 1.08-2.02) for a score of 2; and 1.84 (95% CI, 1.29-2.62) for a score of 3 to 4 (P for trend =.001). Compared with the lowest quartile group, the adjusted OR for hostility was 1.06 (95% CI, 0.76-1.47) for quartile 2; 1.38 (95% CI, 1.00-1.91) for quartile 3; and 1.84 (95% CI, 1.33-2.54) for quartile 4 (P for trend

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    • ") found that harsh early family environments were related to chronic negative emotional states, including depression, anxiety, anger expression, and hostility, which in turn predicted baseline diastolic and systolic blood pressure as well as change in systolic blood pressure (components of allostatic load). These chronic negative emotional states have been associated with poor health behavior (Caspi et al., 1997), hypertension (Davidson et al., 2000; Yan et al., 2003), and later health risks, including mortality (Martin et al., 1995). Empirical evidence has also shown that growing up in an adverse family environment leads to reduced psychosocial resources, including social support, and increased health risks (House, Umberson, & Landis, 1988; Kertesz et al., 2007; Seeman, 1996; Taylor, 2010), including metabolic functioning (Lehman, Taylor, Kiefe, & Seeman, 2005). "
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    ABSTRACT: Childhood maltreatment has been linked to numerous negative health outcomes. However, few studies have examined mediating processes using longitudinal designs or objectively measured biological data. This study sought to determine whether child abuse and neglect predicts allostatic load (a composite indicator of accumulated stress-induced biological risk) and to examine potential mediators. Using a prospective cohort design, children (ages 0-11) with documented cases of abuse and neglect were matched with non-maltreated children and followed up into adulthood with in-person interviews and a medical status exam (mean age 41). Allostatic load was assessed with nine physical health indicators. Child abuse and neglect predicted allostatic load, controlling for age, sex, and race. The direct effect of child abuse and neglect persisted despite the introduction of potential mediators of internalizing and externalizing problems in adolescence and social support and risky lifestyle in middle adulthood. These findings reveal the long-term impact of childhood abuse and neglect on physical health over 30 years later. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Child Abuse & Neglect 02/2015; 47. DOI:10.1016/j.chiabu.2015.01.016 · 2.47 Impact Factor
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    • "Whilst there is evidence of a link between psychological factors and hypertension development [23–25], not all studies have found this association [26–29]. These inconsistencies may be due to the fact that the majority of studies to date have used questionnaire measures of psychological symptoms rather than interviews that clearly define clinically significant levels of psychological distress (i.e., psychiatric disorders) which can be distinguished from the somatic symptoms related to any underlying physical disease [23, 24, 26–29]. As such, the objective of the current study was to assess the impact of mood and anxiety disorders on the development of hypertension. "
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    ABSTRACT: Background. Studies assessing the association between psychological factors and hypertension have been equivocal, which may reflect limitations in the assessment of psychological factors. Purpose. To assess the relationship between mood and anxiety disorders, measured using a psychiatric interview, and 1-year incident hypertension. Methods. 197 nonhypertensive individuals undergoing exercise stress testing at baseline provided follow-up data at 1 year. Baseline assessments included a structure psychiatric interview (PRIME-MD), physician diagnosis of hypertension, and measured blood pressure. At follow-up, hypertension status was assessed via self-reported physician diagnosis. Results. Having an anxiety disorder was associated with a 4-fold increase in the risk of developing hypertension (adjusted OR = 4.14, 95% CIs = 1.18-14.56). In contrast, having a mood disorder was not associated with incident hypertension (adjusted OR = 1.21, 95% CIs = 0.24-5.86). Conclusions. There are potential mechanisms which could explain our differential mood and anxiety findings. The impact of screening and treatment of anxiety disorders on hypertension needs to be explored.
    International Journal of Hypertension 02/2014; 2014:953094. DOI:10.1155/2014/953094
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    • "To investigate the degree of DM risk based on urinary arsenic concentrations, odds ratios (OR) for the prevalence of DM were calculated using the lowest arsenic quartile subgroup as the standard and the effect of all other significant confounders was adjusted for using logistic regression. Testing for linear trends was performed for the coefficients of the continuous version of the arsenic quartile entered in the same models (24). To clarify the relationships between insulin sensitivity/secretion indices and urinary arsenic concentration, multiple linear regression models were used. "
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    ABSTRACT: It has been suggested that there is an association between environmental, low-level arsenic exposure and the risk of diabetes mellitus (DM), but little research has been conducted. Here, the glucose tolerance status and urinary creatinine adjusted total arsenic concentrations were analyzed in 3,602 subjects ≥ 20 yr of age who were registered for the Korea National Health and Nutrition Examination Survey, 2008-2009. Various demographic parameters were associated with urinary arsenic concentrations. After adjusting for these variables, urinary arsenic concentrations in subjects with DM were significantly higher than those in subjects with normal glucose tolerance and those with impaired fasting glucose (P < 0.001). Compared with the lowest quartile ( < 70.7 µg/g creatinine), the odds ratios and 95% confidence intervals for DM were 1.11 (0.73-1.68), 1.42 (0.94-2.13), and 1.56 (1.03-2.36) for urinary arsenic concentrations of 70.7 to < 117.7, 117.7 to < 193.4, and ≥ 193.4 µg/g creatinine, respectively, following multivariate adjustment. Furthermore, the urinary total arsenic concentration was inversely associated with the insulin secretion index, HOMA2 %B (β = -0.033, P = 0.032). These findings suggest that arsenic exposure, possibly involving beta cell dysfunction, is associated with an increased risk of DM in the Korean population.
    Journal of Korean medical science 06/2013; 28(6):861-8. DOI:10.3346/jkms.2013.28.6.861 · 1.27 Impact Factor
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