ArticleLiterature Review

Psychosocial Factors and Hypertension

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Abstract

Black people have the highest prevalence of hypertension in the United States. Evidence suggests that psychosocial factors increase the risks for hypertension and help to account for racial differences in this condition. This article reviews research on psychosocial factors and hypertension, and contextualizes the findings within a health disparities framework. A wide range of psychosocial factors contribute to hypertension but understanding remains limited about how these factors relate to each other and accumulate to contribute to hypertension disparities. Future research on psychosocial factors and hypertension needs to enhance the effectiveness of interventions to reduce hypertension risk in ethnic minority communities.

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... Just as there are psychosocial and behavioral factors associated with coronary heart disease, a set of similar factors are also associated with essential hypertension. Factors associated with risk of hypertension include age, family history of hypertension, "borderline" high blood pressure, dietary intake of salt, and obesity (Cuevas et al., 2017). As is the case with CHD, there are numerous social, environmental, and cultural factors that interact with genetic background in predisposing individuals to hypertension, and attention has been paid to studying the role of stress and personality factors in the development of this disorder. ...
... As is the case with CHD, there are numerous social, environmental, and cultural factors that interact with genetic background in predisposing individuals to hypertension, and attention has been paid to studying the role of stress and personality factors in the development of this disorder. Among the social and psychological factors associated with hypertension are social disadvantage, perceived racism and discrimination, job strain and occupational stress, unemployment, and certain personality characteristics (Cuevas et al., 2017, Cuffee et al., 2014. ...
... Studies of personality factors associated with the development of hypertension have been conducted for more than 75 years. Results have been mixed at best, with some studies indicating that traits such as neuroticism, anxiety, and anger are associated with the development of hypertension and other studies yielding negative results (Cuffee et al., 2014, Cuevas et al., 2017. For example, one study of young adults found that traits of hostility and time urgency predicted the development of hypertension at 15-year follow-up (Yan et al., 2003). ...
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Cardiovascular disorders are the leading causes of death in developed countries. The chapter provides an overview of behavioral and psychosocial influences on cardiovascular disorders, with an emphasis on coronary heart disease (CHD) and hypertension. This chapter reviews the pathophysiology of CHD, the role played by standard biological, behavioral, and psychosocial risk factors, including social determinants of health, environmental and psychological stress, individual psychological characteristics, and psychosocial protective factors such as social support. The chapter provides a summary of research examining the utility of interventions targeted at reducing risks of cardiovascular disease associated with psychosocial risk factors.
... The role of psychosocial stress in the development of essential hypertension has attracted increasing attention in the last decades, but it is still a source of considerable controversy. Research findings have been often inconclusive, and large heterogeneity exists among studies as to the definition of stress and methodological quality (Sparrenberger et al., 2009;Spruill, 2010;Mann, 2012;Cuffee et al., 2014;Cuevas et al., 2017;Liu et al., 2017;Mocayar Marón et al., 2019). Since hypertension remains the major preventable cause of cardiovascular disease and evidence demonstrates that lowering blood pressure can substantially reduce premature morbidity and mortality (Williams et al., 2018), the role of psychosocial stress in the development and progression of hypertension demands special consideration. ...
... Several psychosocial factors (occupational stress, low socio-economic status, racial discrimination, marital stress, social isolation, negative emotional states) have been found to be associated with higher circulating levels of catecholamines, higher cortisol levels, exaggerated cardiovascular response, increased blood pressure over time, and greater risk for the onset of hypertension (Everson-Rose and Lewis, 2005;Sparrenberger et al., 2009;Spruill, 2010;Cuffee et al., 2014;Cuevas et al., 2017;Liu et al., 2017;Gillespie, 2019). Maladaptive behavioral responses (such as poor adherence to treatment, obesity, physical inactivity, alcohol consumption and smoking) do also account, to a considerable extent, for the association between psychosocial stress and hypertension (McCubbin et al., 2018;Williams et al., 2018). ...
Article
The role of psychosocial stress in the development of essential hypertension has attracted increasing attention in the last decades, even though research findings have been often inconclusive. We specifically investigated allostatic overload (AO) in hypertensive patients using a clinimetric approach. Allostatic overload was assessed by a semi-structured research interview based on clinimetric criteria in 80 consecutive outpatients with essential hypertension (46.3 % females; mean age 62.18 ± 8.59 years; age range 47-74 years) and 80 normotensive matched controls. Three clinical interviews and two self-rating questionnaires for assessing psychological distress and well-being were also administered. Cardiac variables were collected. AO was present in 26 (32.5 %) of the hypertensive patients based on clinical interviewing, and in only 6 normotensive controls (p < .001). Hypertensive patients with AO had significantly higher levels of psychological distress than those without. Further, patients with AO displayed significantly lower levels of well-being and quality of life (p < .001). A significantly greater prevalence of psychosomatic syndromes was found to be associated with the presence of AO (p < .05), whereas no significant association was detected as to psychiatric diagnoses. Significantly greater cardiovascular risk was found among hypertensive patients reporting AO compared to those without (p < .05). The results of this study support the clinical relevance of a psychological assessment of hypertensive patients, with important implications for the non-pharmacological management of hypertension.
... A growing body of literature has identified a broad range of psychological and social factors that are relevant for predicting cardiovascular disease risk factors (CVDRF) such as hypertension and diabetes (Spruill et al., 2019). For example, individuals with high levels of depressive symptoms, specific subsets of personality traits, including trait anxiety and certain social factors (e.g., racism related vigilance) were more likely to develop hypertension or diabetes than those with lower levels of these psychosocial factors (Hicken et al., 2014;Baek et al., 2016;Hackett & Steptoe, 2016;Cuevas et al., 2017;Johnson, 2019;Graham et al., 2020;Kubzansky et al., 2020;Levine et al., 2021). In addition to conferring higher risks, psychosocial factors have important implications for achieving optimal CVDRF levels for individuals with a risk factor. ...
... Similarly, the "Distressed and Disadvantaged" profile in the current study was marked by the highest values of CES-D, and chronic burden stressors, lowest values of social support, in addition to the lowest values of positive psychological variables including perceived control and optimism. In addition, the "Distressed and Disadvantaged" profile further supports research showing that elevated depressive symptoms are often co-morbid with chronic conditions including hypertension (Cuevas et al., 2017;Hackett & Steptoe, 2016). ...
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Psychosocial factors are associated with the achievement of optimal cardiovascular disease risk factor (CVDRF) levels. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing psychosocial profiles among individuals with CVDRF. Further, it is unknown whether profiles are associated with achievement of CVDRF levels longitudinally. Therefore, we characterized psychosocial profiles of individuals with CVDRF and assessed whether they are associated with achievement of optimal CVDRF levels over 15 years. We included 1148 CARDIA participants with prevalent hypertension, hypercholesterolemia and/or diabetes mellitus in 2000–2001. Eleven psychosocial variables reflecting psychological health, personality traits, and social factors were included. Optimal levels were deemed achieved if: Hemoglobin A1c (HbA1c) < 7.0%, low-density lipoprotein (LDL) cholesterol < 100 mg/dl, and systolic blood pressure (SBP) < 140 mm Hg. Latent profile analysis revealed three psychosocial profile groups “Healthy”, “Distressed and Disadvantaged” and “Discriminated Against”. There were no significant differences in achievement of CVDRF levels of the 3 targets combined across profiles. Participants in the “Distressed and Disadvantaged” profile were less likely to meet optimal HbA1c levels compared to individuals in the “Healthy” profile after demographic adjustment. Associations were attenuated after full covariate adjustment. Distinct psychosocial profiles exist among individuals with CVDRF, representing meaningful differences. Implications for CVDRF management are discussed.
... 24,25,35,62,63 Furthermore, these findings are also consistent with previous studies linking these stressors to CVD and diabetes among Black adults. 61,[64][65][66] Together, the present study suggests that non-Hispanic Black adults are at an increased risk of hypertension and diabetes through their higher likelihood of experiencing an overall pattern of unmet needs as well as unmet financial needs. These findings also extend the literature on social status and discrimination by including these indicators in a comprehensive measure of stress related to hypertension and diabetes. ...
Article
Background Hypertension and diabetes disproportionately affect older non‐Hispanic Black and Hispanic adults in the United States. Chronic stress may partially explain these disparities. This study identified underlying stress profiles of older US adults, analyzed stress profiles in relation to hypertension and diabetes, examined the distribution of stress profiles by race and ethnicity, and assessed patterns of change in latent classes of stress over time. Methods and Results Latent class analysis was conducted with a nationally representative sample of older US adults who completed 3 waves of the HRS (Health and Retirement Study) (ie, 2010 [n=6863], 2014 [n=4995], and 2018 [n=3089]). Latent classes of stress in 2010 (ie, stress profiles) were identified using 15 indicators of unmet needs within 5 categories (ie, physiological, safety/security, belonging, esteem, and self‐fulfillment). Hypertension and diabetes status were examined as outcomes of latent class membership at 3 time points, and race and ethnicity were examined in association with class membership, adjusting for sociodemographic covariates. Finally, a latent transition analysis examined the stability of latent class membership and racial and ethnic differences in the patterns of stress profiles experienced from 2010 to 2018. Five classes were identified: Generally Unmet Needs (13% of sample), Generally Met Needs (42% of sample), Unmet Self‐Efficacy/Goal Needs (12% of sample), Unmet Financial Needs (20% of sample), and Unmet Social Belonging Needs (13% of sample). Compared with the Generally Met Needs class, the Generally Unmet Needs class had higher odds of hypertension (odds ratio [OR], 1.80; [95% CI, 1.35–2.39]) and diabetes (OR, 1.94; [95% CI, 1.45–2.59]), and the Unmet Financial Needs class had higher odds of diabetes (OR, 1.50; [95% CI, 1.10–2.05]). Non‐Hispanic Black participants compared with non‐Hispanic White participants had higher odds of being members of the Generally Unmet Needs, Unmet Self‐Efficacy/Goal Needs, and Unmet Financial Needs classes (OR, 2.70; [95% CI, 1.59–4.58]; OR, 1.99; [95% CI, 1.15–3.43]; and OR, 4.74; [95% CI, 3.32–6.76], respectively). Class membership remained relatively stable over time, with 93% of participants remaining in Generally Met Needs and 78% of participants remaining in Generally Unmet Needs across time points. Compared with non‐Hispanic White participants, non‐Hispanic Black participants had lower odds of Generally Met Needs class membership at any time point (OR, 0.60; [95% CI, 0.42–0.84]) and had lower odds of moving into the Generally Met Needs class and higher odds of moving into the Unmet Financial Needs class from 2010 to 2014 (OR, 0.33; [95% CI, 0.13–0.86]; and OR, 3.02; [95% CI, 1.16–7.87], respectively). Conclusions Underlying classes of stress based on unmet needs were associated with hypertension and diabetes status. Racial and ethnic differences were observed for both latent class membership and transitions between classes over time. Latent classes of stress associated with unmet needs, hypertension, and diabetes and the ability to transition between classes may explain the perpetuation of racial and ethnic disparities in cardiovascular health. Interventions targeting unmet needs may be used to confront these disparities.
... Kleinräumige Analysen in Nordostdeutschland legen nahe, dass regionale Unterschiede der Prävalenz zumindest teilweise auf Variationen der sozioökonomischen regionalen Lage zurückgeführt werden können [11]. International existieren zahlreiche Studien, die eine positive Assoziation zwischen sozialer Benachteiligung und der Erkrankungslast von Hypertonie aufzeigen, sowohl in Bezug auf die individuelle als auch die regionale sozioökonomische Situation [12,13]. Studien zu möglichen alters-und geschlechtsabhängigen Unterschieden im Einfluss sozioökonomischer Variablen auf die Häufigkeit der Hypertonie wurden bisher nur selten durchgeführt und weisen teilweise widersprüchliche Ergebnisse auf [14]. ...
Article
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Background Hypertension is a common medical condition and a major risk factor for cardiovascular diseases. The aims of the current study were to estimate the diagnosis prevalence of hypertension in Germany and to assess temporal trends and regional variations in hypertension prevalence giving special attention to the influence of regional socioeconomic status. Methods Annual raw and age-sex standardized diagnosis prevalence of hypertension was estimated for Germany and on the level of regional Associations of Statutory Health Insurance Physicians based on a full sample of ambulatory claims data from the years 2009 to 2018. Patients diagnosed with hypertension in at least two quarters of a given year were considered as prevalent cases (M2Q criterion). The association of regional socioeconomic status and hypertension diagnosis was examined using age-sex stratified multilevel poisson regression. Results In 2018 19 million insurants were diagnosed as having hypertension, corresponding to a raw diagnosis prevalence of 26.3%. Annual diagnosis prevalence rose from 2009 to 2016, but decreased in the two following years. The age-sex standardized prevalence in 2018 was 6 percentage points higher in East Germany than in West Germany. In contrast to men, women exhibited a higher raw (27.4% vs. 25.1%) but a lower age standardized prevalence (women: 24.2%, men: 26,1%). Among East German residents in the age group 20 to 49 years the risk of prevalent hypertension increased markedly with decreasing regional socioeconomic status. Conclusion Considerable regional variation of hypertension prevalence underscores varying demands for the allocation of ambulatory healthcare services. An elevated risk of hypertension among young and middle aged East German adults living in regions with low socioeconomic status should be addressed in community-based public health interventions.
... 9 Genetic, environmental and psychosocial factors play a very important part in the development of hypertension; among the psychosocial factors, depression and stress have already been studied in other populations, 10 and their association with hypertension has been clearly established. 11,12 However, there are no conclusive data in Colombia. ...
Article
Introduction Psychosocial factors have been shown to be potentiators and triggers of cardiovascular diseases such as hypertension. The purpose of the study is to explore the relationship between psychosocial factors and the presence of hypertension in a random population sample in the city of Medellin. Methods Observational cross-sectional study with an analytical approach. The endpoint (hypertension) was contrasted with the psychosocial and sociodemographic endpoints by means of a bivariate analysis, and later a multivariate logistic regression analysis was carried out. Results After adjusting for age, gender and stressful life events, depression (OR = 1.65; 95% CI: 1.13–2.41) and sleep disorders (OR = 1.41; 95% CI: 1.00–1.98) were found to be psychosocial factors associated with hypertension. Conclusions Depression and sleep disorders are related to hypertension. In Colombia there are studies that correlate psychosocial factors such as depression with hypertension; however, the impact of sleep disorders on the population is unknown.
... For example, air pollution increases the risk of hypertension and diabetes (Coogan et al., 2012) and has been proposed as a risk factor for COVID-19 (Zhu, Xie, Huang, & Cao, 2020). The racialized structure of American labor entails differential exposure to COVID-19 (Hawkins, 2020) and to occupational stressors related to hypertension (Cuevas, Williams, & Albert, 2017). Mass incarceration unjustly impacts Black people and communities, with consequences for both COVID-19 and cardiometabolic disease. ...
... Emerging evidence suggests that the combination of both an HDP and elevated symptoms of depression or anxiety during pregnancy further increases the risk of adverse obstetrical outcomes including lower birth weight and lower gestational age at birth (Hilmert et al., 2008;Horsley, Tomfohr-Madsen, Ditto, & Tough, 2019), with one recent study reporting that reduced gestational age is associated with HDP at all percentiles of self-reported depression or anxiety symptoms (Horsley et al., 2019). Psychosocial factors such as chronic stress and elevated symptoms of depression and anxiety have been shown to precede development of hypertension in the general population, and there are indications that similar associations are present in pregnancy (Cuevas, Williams, & Albert, 2017;Meng, Chen, Yang, Zheng, & Hui, 2012;Yan et al., 2015;Zhang et al., 2013). There are several theorized biological mechanisms supporting depression and/or anxiety as risk factors for the development of hypertensive disorders, such as autonomic dysregulation, neuroendocrine system disruption, and elevated behavioral health risk factors (McEwen, 2007;Rouleau et al., 2016;Strine et al., 2008;Winkel et al., 2015). ...
Article
Background: Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP. Methods: A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to 'pregnancy', 'anxiety', 'depression', and 'hypertensive disorders'. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP. Results: In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25-1.54]. Conclusions: When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07-1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.
... 8 Meanwhile, previous studies have shown that high blood pressure health literacy (HBP-HL) is one of the significant factors for HRQoL in hypertensive patients and is positively correlated with HRQoL. [9][10][11] HBP-HL refers to the ability to obtain and use hypertension-related knowledge and healthcare services to manage hypertension. 12 A 10-region prospective study in China showed that the prevalence of hypertension was highest in Zhejiang (44.4%), but only 6.83% of hypertensive patients have adequate HL. 13 14 The lower the HBP-HL, the worse the ability to understand health information, and the worse the ability to adopt health behaviours and manage the health. ...
Article
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Objectives The prevalence of hypertension is increasing worldwide. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL) and social support (SS), which may have an impact on health-related quality of life (HRQoL) and lead to poorer clinical outcomes. However, the potential mechanism of HBP-HL, SS and HRQoL remains unclear. The aim of this study was to investigate the association among HBP-HL, SS and HRQoL among community patients with hypertension in China. Design A community-based cross-sectional survey. Setting The community health service center in Huzhou, China. Participants 406 community patients with hypertension were investigated from June to October 2019. Primary outcome measures HRQoL was assessed using the Quality of Life Instruments for Chronic Diseases-Hypertension V2.0, HBP-HL was assessed with the HBP-Health Literacy Scale into Chines and SS was assessed with the Social Support Rating Scale. Results Compared with moderate level of HRQoL and SS, HBP-HL of community hypertensive patients was significantly deficient. Overall, 93 patients (23.2%) lacked HBP-HL, 308 patients (76.8%) had a medium level of HBP-HL, and none of them had sufficient HBP-HL. Correlation analysis showed that HBP-HL, SS and HRQoL were positively correlated (p<0.01). The significant differences in HRQoL and SS were detected in HBP-HL level (p<0.001). In multiple linear regression models, HRQoL was significantly associated with ‘Print HL’ and ‘Medication Label’ of HBP-HL (p<0.05) and all three dimensions of SS (p<0.05). In addition, The bootstrap method was used to examine the indirect effect among variables. The results showed that SS played a mediating role between HBP-HL and HRQoL (p<0.001). Conclusion There is an association among HBP-HL, SS and HRQoL in community hypertension patients. HBP-HL can directly affect HRQoL, and through SS mediate the HRQoL. Community intervention for hypertension management should consider HBP-HL promotion and social engagement as the breakthrough points to increase the impact on patients’ HRQoL.
... Moreover, higher scores of ESAS symptoms of stress and anxiety were associated with higher value of systolic or diastolic blood pressure. These data are in line with emerging evidence that considers psychological and social factors as contributors of hypertension, in hemodialysis patients [62,63]. ...
Article
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Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs.
... Ginty et al. found a correlation among emotional personality traits such as anxiety, anger, depression, and hypertension (Ginty et al. 2013). Cuevas et al. referred to the role of tension-related factors and the occurrence of hypertension (Cuevas et al. 2017). Ill-Gwang et al. in their research indicated that those with mental stress were more affected by hypertension than those who had good mental health (Kim et al. 2015). ...
Article
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Background Diseases induced by lifestyle account for a high rate of disabilities. Thus, the present research aimed to compare the lifestyles of women affected by blood hypertension and healthy women. Objective and Method In this comparative study, 420 women referred to Bandar Abbas healthcare centers were selected through a mixed method (clustered and systematic randomized) and were divided into two groups including the healthy (n = 210) and hypertension groups (n = 210). The standardized Life-Style Questionnaire (LSQ) was used for data collection. The data were statistically analyzed using SPSS software version 19. Descriptive (mean and standard deviation) and inferential (chi-square test, independent-samples t-test, Pearson correlation coefficient) statistics were used to analyze the data. Results The significance level was set at p ˂ 0.05. The mean age of the hypertension group was 45.65 ± 9.61 years old, while for the healthy group it was 44.68 ± 8.70 years old. In the former group, the strongest correlation belonged to the mental health dimensions (r = 0.709, p ˂ 0.001) and spiritual health (r = 0.660, p ˂ 0.001). Conclusion The results of the present study revealed that raising public awareness helps to recognize risk factors and correct lifestyles, and planning to educate people and instructing them on how to manage mental pressures can reduce the pressure induced by diseases such as hypertension.
... The role of depression and mental stress, including the stress at work place have been established as important causative factors for coronary heart disease and hypertension (Khayyam-Nekouei et al., 2013). Possible factors leading to development of coronary heart disease and hypertension include personality traits, hypothalamic-pituitary activation, higher sympathetic activity (Cuevas et al., 2017), reduced parasympathetic tone , reduced heart rate variability, endothelial dysfunction, increased platelet reactivity and endothelial inflammation leading to athero-thrombogenesis. (Fioranelli et al., 2018). ...
... Among psychiatric disorders, anxiety is the most prevalent in the general population, with prevalence rates between 5.6% and 18.1% [28]. In women, this prevalence is higher than in men, being a risk factor for elevated BP [9,[29][30][31], which can constitute a barrier to non-BP control [9,32]. According to a study by the Global Burden of Disease [33], the sixth leading cause of disability in the world is related to mental disorders, and individuals affected with anxiety symptoms have lower quality of life and worse psychosocial factor. ...
Article
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Background and Objective: The routine practice of self-medication of blood pressure (BP) not oriented with pulse devices may not be precisely useful in the control of BP and can lead the patient to self-medicate in error. Thus, we need to evaluate the non-oriented self-assessment of BP in real-life circumstances in hypertensive patients. The objective of this study was to evaluate in hypertensive patients the association of BP self-measurement with its control, as well as the presence of anxiety disorders, the occurrence of unscheduled visits to the emergency room, and self-medication. Materials and Methods: An observational study was carried out with 1000 hypertensive volunteers (age: 61.0 ± 12.5). Using a questionnaire, sociodemographic and clinical data on BP control were collected. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI). Results: The group that performed non-oriented self-measurement of BP, showed that they had higher frequencies of self-medication (57.9%, p < 0.05) and more unscheduled visits to the emergency room (68%, p < 0.05). In addition, a lower level of BP control (46.8%, p < 0.05) was associated with higher levels of anxiety (52.3%, p < 0.05) in the group that performed non-oriented self-measurements of BP. Conclusion: The practice of non-oriented self-assessment of BP was associated with negative factors such as high levels of anxiety and higher frequencies of self-medication and unscheduled emergency visits.
... Consistent with Cuevas et al., [22], our participants indicated psychological problems such as sadness, suicidal tendencies, fear, and anxiety, probably resulting from misconceptions about HPT and its complications [49]. These misconceptions, largely broadcast on television and radio stations by untrained health professionals seeking to portray HPT as an unmanageable condition persistently reminded them of their likelihood of dying from the complications of HPT, thereby increasing their level of anxiety and fear. ...
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Background Hypertension (HPT) is an essential public health problem affecting both lower and middle-income countries disproportionately. Evidence suggests that HPT is the leading risk factor for cardiovascular diseases and chronic kidney disease. Yet, challenges faced by patients with HPT in Ghana are not sufficiently explored. This study, documents the challenges patients with HPT face in Ghana. Methods We used an explorative descriptive qualitative design. Face-to-face in-depth interviews were conducted with 15 patients with HPT. Interviews were recorded and transcribed verbatim. A thematic content analysis procedure was followed to analyse the data. Results Four main themes emerged from interviews; three of which pertained to dimensions of challenges and a fourth which pertained to coping strategies. These include: [1] impairment in physical activities and mobility constraints [2]. Psychological challenges such as suicidal ideations, sadness, fear, anxiety, and reduced sexual affection [3]. Socio-economic challenges identified include loss of friends and social network, difficulty in job demands, and financial burden, and [4] coping strategies such as health system support, social support, and religiosity were identified. Conclusion Patients with HPT experience an array of challenges. We suggest that health care facilities incorporate post HPT diagnosis counseling sessions for HPT patients in the study area. Also, the National Health Insurance Authority (NHIA) should re-examine their scope of services; thus, drugs, laboratory services, and electrocardiogram services to avoid the issue of co-payment. Collaboration between healthcare professionals and family relations of patients with HPT ought to also be strengthened to ensure optimal care.
... Los estudios realizados confirman la multicausalidad de la HTA, y aun cuando se han encontrado claras asociaciones entre algunos factores clásicos -obesidad, dislipemias, síndrome metabólico y diabetes mellitus-, su incidencia continúa en aumento 9 . Factores genéticos, ambientales y psicosociales tienen parte muy importante en el desarrollo de la HTA; del grupo de factores psicosociales, la depresión y el estrés se han estudiado previamente en otras poblaciones 10 , y su asociación con la HTA está claramente establecida 11,12 , pero no hay datos concluyentes en Colombia. ...
Article
Resumen Introducción Los factores psicosociales se han mostrado como potenciadores y desencadenantes de enfermedades cardiovasculares como la hipertensión arterial. El propósito del estudio es explorar la relación de los factores psicosociales con la presencia de hipertensión arterial en una muestra aleatoria poblacional en la ciudad de Medellín. Métodos Estudio de tipo observacional de corte transversal con enfoque analítico. La variable respuesta (hipertensión arterial) se contrastó con las psicosociales y sociodemográficas mediante análisis bivariable, y posteriormente se realizó un análisis de regresión logística multivariable. Resultados Tras ajustar por edad, sexo y eventos de vida estresantes, los factores psicosociales asociados con hipertensión arterial son la depresión (OR = 1,65; IC95%, 1,13-2,41) y los trastornos del sueño (OR = 1,41; IC95%, 1,00-1,98). Conclusiones La depresión y los trastornos del sueño se relacionan con la hipertensión arterial. En Colombia hay estudios que relacionan factores psicosociales como la depresión con la hipertensión, pero se desconoce el impacto de los trastornos de sueño en la población.
... Proinflammatory and oxidative stress pathways have been posited as underlying biological mechanisms for CVD. Potential pathways linking psychosocial stressors and CVD involve neuroendocrine activity of the autonomic nervous system (ANS) and the hypothalamus-pituitary adrenal (HPA) axis [31]. Ambient air pollutants are capable of mediating adverse cardiovascular responses through several mechanisms, such as impacting endothelial and other hemodynamic function, triggering acute autonomic imbalance and oxidative stress in the lungs with systematic inflammatory responses [15][16][17][18][19][20]. ...
Article
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Purpose: Independent and combined effects of air pollution and psychosocial stressors on hypertension, a risk factor for cardiovascular disease, among Hispanics are not well studied. Methods: We administered a pilot-tested questionnaire on individual- and neighborhood-level psychosocial stressors, developed with community input, to nearly 2500 individuals from the MD Anderson Cancer Center cohort of Mexican-Americans. We used data from local air quality monitors to estimate individual exposures to ozone (O3) and fine particulate matter (PM2.5) for the 12-month period preceding enrollment using inverse distance interpolation. We applied logistic regression models to examine relationships between exposures to psychosocial stressors and air pollution with prevalent hypertension and used stratified analyses to examine the interacting effects of these two exposures on hypertension. RESULTS: There was a positive association between prevalent hypertension and a high frequency of feeling anxious or depressed (prevalence odds ratio (POR) = 1.36, 95% CI [1.06-1.75]) and experiencing aches and pains (POR = 1.29, 95% CI [1.01-1.64]). The odds of having hypertension were also elevated among those worrying about their own health (POR = 1.65, 95% CI [1.30-2.06]) or about not having enough money (POR = 1.27, 95% CI [1.01-1.6]). We observed an inverse association between O3 and hypertension. There was no interaction between psychosocial stressors and O3 on hypertension. Conclusion: Our findings add to the evidence of a positive association between individual and family stressors on hypertension among Hispanics and other racial/ethnic groups. Contrary to previous studies reporting positive associations, our results suggest that long-term exposure to O3 may be inversely related to prevalent hypertension.
... These behaviors contribute to several risk factors, such as hypertension and obesity [22,25], which are associated with NCDs [22]. Additionally, work-related requirements play a role in the development and progression of hypertension, for example, long working hours [26], shift work [27], and psychosocial factors [28,29]. Studies in South Africa have reported that NCDs, unhealthy lifestyle factors, hypertension and stressors are prevalent among employees in workplaces [18,[30][31][32]. ...
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A large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular diseases in South Africa. A workplace may either mitigate or accentuate the risk factors for hypertension. A cross sectional study was conducted to determine the prevalence of undiagnosed hypertension and associated factors among 312 employees in a Logistics Company, South Africa. A modified, validated, self-administered WHO STEPwise questionnaire was used to collect data on demography, lifestyle factors, anthropometry and blood pressure (BP). Hypertension was defined at BP ≥ 140/90 mmHg. Data was analysed using STATA 14. Mean age of employees was 40 ± 10 years, with a 50% prevalence of undiagnosed hypertension. No significant association was observed between occupation and undiagnosed hypertension, except for high prevalence of undiagnosed hypertension among truck drivers and van assistants (43%), and general workers (27%), having higher odds of increased waist-to-height ratio. Hypertension was associated with age (OR = 2.3, 95%CI; 1.21–4.27), alcohol use (AOR = 1.8, 95%CI; 1.05–2.93), waist circumference (AOR = 2.3, 95%CI; 1.29–4.07) and waist-to-height-ratio (AOR = 3.7, 95%CI; 1.85–7.30). Improved and effective workplace health programs and policies are necessary for management of undiagnosed hypertension among employees. Longitudinal studies on mediation of occupation in association of demographic and lifestyle factors with hypertension in workplaces are needed.
... There are also psychosocial factors such as anxiety and depression that have been shown to be associated with the development/worsening of hypertension (11,12), yet, they haven't been extensively explored in relation to awareness, treatment, and control of hypertension. Similarly, health-related quality of life has been shown to be poor in patients with hypertension (13), but it is not clear how it can be important in relation to hypertension awareness, treatment, and control. ...
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Background: Hypertension, the most significant risk factor for cardiovascular disease, is an increasing contributor to global health burden, particularly in low- and middle-income countries (LMICs) such as India. While the rates of hypertension awareness, treatment, and control in India have been reported in several studies, the factors associated with these rates are less well-understood. Existing studies are predominantly cross-sectional, and the factors examined are limited. Understanding the predictors associated with these rates, using more rigorous study designs, is crucial for the development of strategies to improve hypertension management. Aims: To examine a range of factors associated with hypertension awareness, treatment, and control using both cross-sectional and longitudinal analyses. Methods: Data was derived from a population-based sample of 1,710 participants from Kerala, aged 30–60 years. We examined a comprehensive range of factors, including demographic, behavioral factors, anthropometric, clinical measures, psychosocial factors and healthcare utilization. Multilevel mixed effects logistic regression was used for both cross-sectional and longitudinal analyses (repeated measures for all variables across 2 years) to determine the factors associated with awareness, treatment, and control of hypertension. Results: A total of 467 (27.3%) participants had hypertension at baseline. Among those, the rates of awareness, treatment, and control of hypertension were 54.4, 25.5, and 36.4%, respectively. Being male (OR 0.27, 95% CI 0.14–0.53) and consumption of alcohol (OR 0.49, 95% CI 0.31–0.80) were significant predictors of poorly controlled hypertension (longitudinal analysis). Depression (OR 2.04, 95% CI 1.15–3.61) and fair-to-poor self-perceived health status (OR 1.87, 95% CI 1.15–3.04) were associated with increased hypertension awareness, whereas anxiety (OR 1.97, 95% CI 1.04–3.71) was associated with increased hypertension treatment (cross-sectional analysis). Seeking outpatient service in the past 4 weeks was associated with higher awareness (OR 1.09, 95% CI 1.27–2.87), treatment (OR 1.73, 95% CI 1.20–2.50) and control (OR 1.96, 95% CI 1.37–2.80) (longitudinal analysis). Conclusion: Our findings suggest the importance of considering psychosocial factors and better engagement with health services in hypertension management, as well as giving more attention to body fat control and largely male-related behaviors such as alcohol consumption, taking into account of some Indian specific attributes.
... The pressor response by CPT is induced by enhanced sympathetic nerve activity and by increased cardiac output during the initial period (Yamamoto, Iwase, & Mano, 1992;Ifuku, 2015). Undoubtedly, psychological stress is one of the most important factors (Sanchez-Gonzalez, May, Brown, Koutnik, & Fincham, 2013;Cuevas, Williams, & Albert, 2017). Participants experience the CPT as painful and demonstrate increased levels of perceived stress and arousal during and imedaiately after the experiment, which demonstrates changes on the subjective level as well (al'Absi et al., 2002;Zoladz et al., 2014). ...
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Hypertension is one of the leading diseases of the cardiovascular system. It is manifested by changes in arterial stiffness. Cardiovascular reactivity, especially blood pressure (BP), changes during the cold pressor test (CPT) depending on various factors. Undoubtedly, stress is one of the most important factors. The aim of the study is to investigate the various effects of CPT on cardiovascular responses in healthy young subjects. 56 healthy individuals aged between 21 and 26 years have been investigated. The Cardiovascular responses (BP, heart rate, aortic pulse wave velocity) to CPT were recorded by using the applanation tonometry. The Medical Outcomes Study Sleep Scale and the State-Trait Anxiety Inventory were assessed. 32,14%(n=18) of individuals who had showed difference in systolic BP more than 22 mm of Hg and difference in diastolic BP more than 18 mm of Hg after the CPT were defined as hyperreactors. Hyperreactors showed a significantly higher increase in sleep disturbances (P > 0.01) and anxiety when compared to the normoreaktors. The CPT used to diagnose cardiovascular reactivity in young individuals and the assessment of perceived stress can help identify candidates for a future risk of hypertonic disease. Keywords: Cold pressor test; cardiovascular reactivity; applanation tonometry; blood pressure; stress
... (1,3,4) However, the full range of factors contributing to disease development is not known. Despite the evidence that personality has an important role in the development of hypertension (5,6,7), personality is not included into hypertension risk predictor models. Most studies examine the role of personality in the development of CVD, instead of directly exploring the relationship between personality and the development of hypertension, the major CVD risk factor. ...
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Objectives: The aim of this case-control pilot study was to examine whether there are differences in personality characteristics between hypertensive and normotensive individuals in terms of the Five-Factor Model (FFM). Methods: 71 individuals with primary hypertension were compared with 84 normotensive individuals on the DECAS personality inventory, assessing the five basic dimensions of personality according to the FFM. Results: Agreeableness and emotional stability were associated with hypertension (p-0,0001 for both). Hypertensive individuals showed low and very low agreeableness and emotional stability whereas normotensives scored medium and high in these two dimensions. Lower emotional stability was a risk factor for hypertension (OR=4.51, CI 95%=2.18-9.35). There were no significant differences in openness, extraversion and consciousness between hypertensives and normotensives (p>0.05). Conclusion: Individuals with low emotional stability/high neuroticism have more than fourfold increased risk of developing hypertension.
... Disparities in hypertension prevention, detection, and control are aided by unequal access to and engagement with healthy environments and the medical system, which, in turn, are rooted in more upstream social determinants of health, including poverty, stress, and racial and ethnic discrimination. [60][61][62][63][64] Attention to place-specific social determinants of health when addressing the troubling trends in hypertension-related CVD mortality will enable all communities to experience equitable improvement in cardiovascular health. ...
Article
Background Amid stagnating declines in national cardiovascular disease (CVD) mortality, documenting trends in county‐level hypertension‐related CVD death rates can help activate local efforts prioritizing hypertension prevention, detection, and control. Methods and Results Using death certificate data from the National Vital Statistics System, Bayesian spatiotemporal models were used to estimate county‐level hypertension‐related CVD death rates and corresponding trends during 2000 to 2010 and 2010 to 2019 for adults aged ≥35 years overall and by age group, race or ethnicity, and sex. Among adults aged 35 to 64 years, county‐level hypertension‐related CVD death rates increased from a median of 23.2 per 100 000 in 2000 to 43.4 per 100 000 in 2019. Among adults aged ≥65 years, county‐level hypertension‐related CVD death rates increased from a median of 362.1 per 100 000 in 2000 to 430.1 per 100 000 in 2019. Increases were larger and more prevalent among adults aged 35 to 64 years than those aged ≥65 years. More than 75% of counties experienced increasing hypertension‐related CVD death rates among patients aged 35 to 64 years during 2000 to 2010 and 2010 to 2019 (76.2% [95% credible interval, 74.7–78.4] and 86.2% [95% credible interval, 84.6–87.6], respectively), compared with 48.2% (95% credible interval, 47.0–49.7) during 2000 to 2010 and 66.1% (95% credible interval, 64.9–67.1) for patients aged ≥65 years. The highest rates for both age groups were among men and Black populations. All racial and ethnic categories in both age groups experienced widespread county‐level increases. Conclusions Large, widespread county‐level increases in hypertension‐related CVD mortality sound an alarm for intensified clinical and public health actions to improve hypertension prevention, detection, and control and prevent subsequent CVD deaths in counties across the nation.
... Perceived discrimination operate like other stressors, in that they are life-long and cumulative and can lead to illness and disease [32][33][34]. Growing attention has been given to the ways in which race/ethnicity-related aspects of social experiences, particularly perceived discrimination, may increase the risk of obesity [35][36][37]. Findings pertaining to the relationship between discrimination and obesity, however, have been mixed. ...
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Background: The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity. Methods: We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors. Results: The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001]. Conclusion: Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.
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Objectives We sought to examine the association between occupational class linked to job stress and the risk of renal cell cancer. To identify potential mediators, we additionally examined whether any observed associations persisted even after controlling for the contribution of stress‐related factors (eg, smoking, hypertension, and obesity). Methods Using nationwide inpatient records (1984 to 2016) from the Rosai Hospital group in Japan, we identified 3316 cases of renal cell cancer (excluding upper tract urothelial cancer) and 168 418 controls. We classified patients' occupational class (blue‐collar workers, service workers, professionals, and managers) and cross‐classified it by industry type (blue‐collar, service, and white‐collar) based on a standardized national classification. Unconditional logistic regression with multiple imputation was used for the analyses. Results A significantly elevated risk of renal cell cancer was found among men in higher occupational class (eg, professionals and managers). The elevated odds in male managers across all industries persisted even after controlling for smoking and alcohol consumption, with the association being more pronounced in blue‐collar industries (OR, 1.61; 95% CI, 1.34‐1.93). The association appeared to be mainly mediated by hypertension. Conclusion Occupational class is associated with the risk of renal cell cancer in men, particularly through modifiable risk factors.
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Introducción.La hipertensión arterial (HTA) es una de las mayores causas de las enfermedades cardiovasculares y la principal causa de mortalidad a nivel mundial, por cuanto participa en el desarrollo de la enfermedad aterosclerótica cardiovascular, en la morbimortalidad por eventos cardiacos, cerebrovasculares, insuficiencia renal y enfermedad vascular periférica, ocasionando más de 3 millones de defunciones cada año. Objetivo.El estudio tiene como objetivo definir los factores de riesgo asociados a la hipertensión arterial en los adultos, y la conceptualización de las características de los adultos mayores con hipertensión arterial que acuden al centro de atención integral que pertenecen al poblado de la pradera de la ciudad de Milagro. Metodología. La investigación es de tipo descriptivo, la muestra es de 234 personas que son atendidas en el Centro de salud de la Ciudadela La Pradera. Resultados. La prevalencia de hipertensión arterial de los adultos mayores de la ciudadela La Pradera fue del 15%, esto es 35 individuos de los 234 de la muestra. Conclusión. Los factores referentes al estado civil, los antecedentes familiares, el estrés, además de los hábitos relacionados al consumo de tabaco, alcohol, comidas altas en grasa y una carencia de actividad física son propicios para incrementar la probabilidad de sufrir esta enfermedad.Palabras clave: Adultos mayores, factores de riesgo, hipertensión.
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The association between religious service attendance, religious coping, and hypertension is unclear. Prospective research and assessment of potential mediators is needed to understand this relationship. From 2001-2013, we prospectively followed 44,281 non-hypertensive women who provided information on religious service attendance and religious coping in the Nurses' Health Study II. Cox regression and mediation analyses were conducted to assess associations between religion and hypertension. There were 453,706 person-years of follow-up and 11,773 incident hypertension cases. Women who attended religious services were less likely to develop hypertension. In the fully adjusted model, compared to women who never or almost never attend religious meetings or services, women attending less than once/month (hazard ratio=0.97, 95% confidence interval: 0.91,1.03), 1-3 times/month (hazard ratio=0.94, 95% confidence interval: 0.88,1.00), once/week (hazard ratio=0.93, 95% confidence interval: 0.88,0.98), or more than once/week (hazard ratio=0.91, 95% confidence interval: 0.86,0.97) showed a decreased risk of hypertension (Ptrend=0.001). Body mass index was an important mediator (11.5%, P<0.001). Religious coping had a marginal association with hypertension. In conclusion, religious service attendance was modestly associated with hypertension in an inverse dose-response manner and partially mediated through body mass index. Future research is needed on biological or social reasons for the lower risk of hypertension.
Article
Background: African Americans develop hypertension earlier and have worse cardiovascular outcomes than Caucasians. Accumulating evidence suggests that psychological distress may play a role in the observed racial differences in hypertension. Several studies have investigated the relationship between depression and hypertension while little is still known about the role of demoralization. Methods: Using data from the Trial Using Motivational Interviewing, Positive Affect, and Self-affirmation in African Americans with Hypertension (TRIUMPH), logistic regression models were used to estimate differences in blood pressure control at 12 months among participants with demoralization, depression, and both conditions. Results: Our logistic models showed that reported psychosocial symptoms significantly differed in predicting success in blood pressure control at 12 months. Contrast analyses showed that, after adjusting for sociodemographic, clinical, and psychosocial variables, demoralized patients were less likely to achieve blood pressure control than participants without affective conditions (p = 0.020). Similar results emerged for patients with depression (p = 0.042) and both conditions (p = 0.022). Conclusions: Depression can be extremely debilitating and has serious health consequence. Our findings confirm this result and show that, even though depression and demoralization share common features, they are two distinct clinical phenomena with similar negative impact on blood pressure control in African Americans.
Article
Objective: To date, most research on perceived discrimination and cardiovascular disease (CVD) has examined racial discrimination although other forms of discrimination may also impact physical and mental health. The current study investigated the relationship between three forms of discrimination (weight, race, and gender) and 3-year incidence of CVD in a large national sample of U.S. adults. Methods: 26,992 adults (55.5% women) who participated in the 2001-2002 and 2004-2005 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) were included in this study. Multiple logistic regression analyses were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for three forms of perceived discrimination (simultaneously included in equations after adjusting for relevant potential confounds) for predicting CVD incidence at Wave 2. Results: Perceived weight and racial discrimination were associated with significantly greater likelihood of reporting myocardial infarction (OR=2.56 [95% CI=1.31-4.98], OR=1.84 [95% CI=1.19-2.84], respectively) and minor heart conditions (OR=1.48 [95% CI=1.11-1.98], OR=1.41 [95% CI=1.18-1.70], respectively). Perceived racial discrimination was also significantly associated with greater likelihood of reporting arteriosclerosis (OR=1.61 [95% CI=1.11-2.34]). Odds ratios for diagnoses of arteriosclerosis, myocardial infarction, and other minor heart disease were largest for individuals reporting multiple forms of discrimination. Conclusions: Adults who experience weight and racial discrimination, and especially multiple forms of discrimination, may be at heightened risk for CVD. Perceived discrimination may be important to consider during assessment of life stressors by health providers. Future research should address the mechanisms that link discrimination and CVD to assist public health and policy efforts to reduce discrimination.
Article
Objective The present study tests the hypothesis that ethnicity and nativity moderate the association of negative racial stereotypes versus perceived discrimination to cardiovascular health among Black respondents to the National Survey of American Life (NSAL). It is also hypothesized that the relationship is strongest in African Americans and weakest in foreign-born Caribbean Blacks with U.S.-born Caribbean Blacks falling in the middle. The same pattern of results is expected to occur for the correlation between perceived discrimination and cardiovascular health. Method A representative sample of 3570 (100%) African American and 1419 (87.4%) of 1623 Caribbean Black respondents to the NSAL had complete data for use in this study. The Caribbean subsample was divided by nativity into 373 (26.3%) U.S.-born and 1044 (73.7%) foreign-born participants. Structural equation modeling (SEM) tested the measurement model for effects of internalized racism and perceived racism on cardiovascular health mediated by perceived mastery and performance apprehension. Results SEM analyses revealed that perceived discrimination had a much stronger effect on cardiovascular health than internalized racism for African Americans and foreign-born Caribbean Blacks, but the diametrically opposite pattern was the case for U.S.-born Caribbean Blacks who reported greater effects for internalized racism than perceived discrimination. Conclusion Interventions and policies to eliminate disparities in cardiovascular health for the U.S. Black population must address internal and external sources of racism by ethnicity and nativity.
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This paper presents and discusses the outcomes of the psychodynamic psychotherapy of a patient with somatic symptom disorder and chronic diseases in a naturalistic setting. The entire treatment included 120 weekly sessions and lasted 30 months. It was interrupted by the patient. The treatment was considered successful in terms of its results. Regarding symptomatic evaluation (assessed by Outcome Questionnaire, OQ‐45), the patient showed an improvement, especially during the three‐month follow‐up assessment period, showing a change from dysfunction to functionality. In relation to personality evaluation (assessed by the Shedler‐Westen Assessment Procedure, SWAP‐200), although structural changes were not completed, the patient achieved a high level of overall functioning (i.e. strengthening of the ego). The clinical evaluation and the measures provided by the instruments were in agreement. This study showed that psychodynamic psychotherapy can help patients who show characteristics such as chronic diseases and operative functioning. Moreover, the pluralistic perspective used for evaluating treatment outcome proved to be very hopeful for improving our understanding of the patient's idiosyncrasies.
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Aim of the study was to understand the relationship of menopausal status with BMI and blood pressure. The study area was selected through multistage sampling technique covering six districts of West Bengal, a state located at the eastern part of India. 1400 participants were selected for the study. The participants were divided into four groups on the basis of menopausal status: early and late perimenopausal; early and late postmenopausal. Results shows that menopausal status was significantly associated with Body Mass Index (BMI) and Mean Arterial Pressure (MAP), after controlling the effect of covariates such as participants’ age, reproductive behavior, diet and addiction to tobacco use.
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Aims Optimism is associated with reduced cardiovascular disease risk; however, few prospective studies have considered optimism in relation to hypertension risk specifically. We investigated whether optimism was associated with a lower risk of developing hypertension in U.S. service members, who are more likely to develop high blood pressure early in life. We also evaluated race/ethnicity, sex and age as potential effect modifiers of these associations. Methods Participants were 103 486 hypertension-free U.S. Army active-duty soldiers (mean age 28.96 years, 61.76% White, 20.04% Black, 11.01% Hispanic, 4.09% Asian, and 3.10% others). We assessed optimism, sociodemographic characteristics, health conditions, health behaviours and depression status at baseline (2009–2010) via self-report and administrative records, and ascertained incident hypertension over follow-up (2010–2014) from electronic health records and health assessments. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and adjusted models for a broad range of relevant covariates. Results Over a mean follow-up of 3.51 years, 15 052 incident hypertension cases occurred. The highest v . lowest optimism levels were associated with a 22% reduced risk of developing hypertension, after adjusting for all covariates including baseline blood pressure (HR = 0.78; 95% CI = 0.74–0.83). The difference in hypertension risk between the highest v . lowest optimism was also maintained when we excluded soldiers with hypertension in the first two years of follow-up and, separately, when we excluded soldiers with prehypertension at baseline. A dose–response relationship was evident with higher optimism associated with a lower relative risk ( p < 0.001). Higher optimism was consistently associated with a lower risk of developing hypertension across sex, age and most race/ethnicity categories. Conclusions In a diverse cohort of initially healthy male and female service members particularly vulnerable to developing hypertension, higher optimism levels were associated with reduced hypertension risk independently of sociodemographic and health factors, a particularly notable finding given the young and healthy population. Results suggest optimism is a health asset and a potential target for public health interventions.
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The coronavirus disease-19 (COVID-19) pandemic has put healthcare workers in an unprecedented situation, increasing their psychological and mental health distress. Much research has focused on the issues surrounding anxiety, depression, and stress among healthcare workers. The consequences of mental health problems on healthcare workers' physical health, health-compromising behaviours, suicide ideation, family relationships, and job satisfaction during the COVID-19 pandemic are not well studied. Enhanced psychological stress has known effects on an individual's physical health. In healthcare workers with pre-existing comorbidities, psychological stressors may exacerbate their current health problems. Healthcare professionals are known to have a high risk of substance use, hence they may be at risk of development of substance use addiction or vulnerable to addiction relapse. Frontline COVID-19 healthcare workers are being pushed above and beyond their limits, possibly resulting in suicidal tendencies. Furthermore, the burden of high workload and burnout may also have serious manifestations in relationships with family and an intention to quit their jobs. Future studies should explore the above-mentioned deleterious consequences to provide insight into the development of mental healthcare strategies to combat the psychological impact of COVID-19 on healthcare workers during the COVID-19 emergency. It is imperative to employ strategies to care for and policies to protect the psychological well-being of healthcare workers.
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While associations between stress and hypertension have been documented, little research has examined the association between coping and hypertension, especially in the context of understanding racial disparities. Utilizing data from the CHDS-DISPAR study, we examine the association between avoidant coping and hypertension among adults age 50 while assessing for potential differences across (1) coping in response to the general stress and discrimination and (2) African American and White racial groups. Coping was measured using a 9-item scale with an avoidant coping subscale (e.g., drinking alcohol). Mean avoidance coping scores were calculated for both general stress and discrimination. No racial differences in avoidant coping were found. Within our sample (n = 414), there was a high burden of hypertension among African American respondents compared to White respondents (50.3% vs. 22.6%). Models assessed associations between avoidant coping and hypertension adjusted for sociodemographic factors, obesity, and either experience of stress or discrimination depending on the coping domain examined. Avoidant coping in response to the general stress and discrimination was associated with increased hypertension among White respondents (PR: 1.63 [95%CI 1.01, 2.24]; PR: 1.69 [95%CI 1.12, 2.26], respectively) and no associations among African American respondents (PR: 0.83 [95%CI 0.57, 1.09]; PR: 0.82 [95%CI 0.52, 1.12], respectively). This research suggests that racial disparities in hypertension may not be attributable to individual-level coping behaviors.
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Hypertension can originate in childhood and remain undetected unless special screening is performed. The burden of hypertension in adolescents in Tunisia is unknown. The aim of this study was to investigate the prevalence of blood pressure (BP) within the hypertension range and its association with other risk factors among Tunisian adolescents. A cross-sectional study that included 1385 secondary school students in Sousse, Tunisia, was performed during 2017–2018. A two-stage cluster sampling strategy was used to obtain a representative sample of the study population. BP within the hypertension range (HBP)was classified following the European guideline recommendations for measuring BP in children and adolescents. Anthropometric indices were measured using a standard protocol. A structured questionnaire collected information about sociodemographic characteristics, lifestyle, mental health status, and addictions. Adjusted logistic regression models were used to assess hypertension-related risk factors. Our study included 39.5% boys and 60.5% girls. The mean age of our population was 17 ± 1.5 years. The prevalence of HBP was 15.4% (13.1–18.0%), and it was significantly higher in boys (22.8%) than in girls (10.6%, p value < 0.001). In the multivariate logistic regression model, overweight [OR = 1.72(1.18–2.51)] and obesity [OR = 3.73(2.55–5.41)] were independent risk factors for HBPrange, (p value < 0.001), whereas female sex [OR = 0.41(0.29–0.56), p value < 0.001] and depression [OR = 0.67(0.51–0.88), p value = 0.008] were independent protective factors. Among Tunisian secondary school adolescents, the prevalence of HBP was high and associated with excess body weight. A comprehensive strategy for the prevention of hypertension and its risk factors among youth is urgently needed.
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African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, Mage = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.
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This study investigated the association between relational-interdependent self-construals (relational interdependence) and blood pressure reactivity and recovery from two types of peer stressors (i.e., relational and instrumental) and gender as a moderator of this association. One hundred and ninety-six early adolescents (M = 10.11 years) reported their relational interdependence and participated in a laboratory stress protocol in which their systolic and diastolic blood pressures before, during, and after experiencing peer stressors were assessed. Results indicated that for males only, those with high relational interdependence showed greater systolic blood pressure reactivity and, at a trend level, impaired recovery from instrumental stressors; females with high relational interdependence showed greater diastolic blood pressure reactivity to relational stressors.
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Early-life experience (ELE) can significantly affect life-long health and disease, including cardiovascular function. Specific dimensions of emotionality also modify risk of disease, and aggressive traits along with social inhibition have been established as independent vulnerability factors for the progression of cardiovascular disease. Yet, the biological mechanisms mediating these associations remain poorly understood. The present study utilized the inherently stress-susceptible and socially inhibited Wistar-Kyoto rats to determine the potential influences of ELE and trait aggression (TA) on cardiovascular parameters throughout the lifespan. Pups were exposed to maternal separation (MS), consisting of daily three-hour separations of the entire litter from postnatal day (P)1 to P14. The rats were weaned at P21, and as adults were instrumented for chronic radiotelemetry recordings of blood pressure and heart rate (HR). Adult aggressive behavior was assessed using the resident-intruder test, which demonstrated that TA was independent of MS exposure. MS-exposed animals (irrespective of TA) had significantly lower resting HR accompanied by increases in HR variability. No effects of MS on resting blood pressure were detected. In contrast, TA correlated with increased resting mean, systolic, and diastolic arterial pressures, but had no effect on HR. TA rats (relative to non-aggressive animals) also manifested: increased wall-to-lumen ratio in the thoracic aorta, increased sensitivity to phenylephrine-induced vascular contractility and increased norepinephrine content in the heart. Together these data suggest that ELE and TA are independent factors that impact baseline cardiovascular function.
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Anxiety and aggression are part of the behavioral repertoire of humans and animals. However, in their exaggerated form both can become maladaptive and result in psychiatric disorders. On the one hand, genetic predisposition has been shown to play a crucial modulatory role in anxiety and aggression. On the other hand, social experiences have been implicated in the modulation of these traits. However, so far, mainly experiences in early life phases have been considered crucial for shaping anxiety-like and aggressive behavior while the phase of adolescence has mainly been neglected. Therefore, the aim of the present study was to elucidate how levels of anxiety-like and aggressive behavior are shaped by social experiences during adolescence and serotonin transporter (5-HTT) genotype. For this purpose, male mice of a 5-HTT knockout mouse model including all three genotypes (wildtype, heterozygous and homozygous 5-HTT knockout mice) were either exposed to an adverse social situation or a beneficial social environment during adolescence. This was accomplished in a custom-made cage system where mice experiencing the adverse environment were repeatedly introduced to the territory of a dominant opponent but had the possibility to escape to a refuge cage. Mice encountering beneficial social conditions had free access to a female mating partner. Afterwards, anxiety-like and aggressive behavior was assessed in a battery of tests. Surprisingly, unfavorable conditions during adolescence led to a decrease in anxiety-like behavior and an increase in exploratory locomotion. Additionally, aggressive behavior was augmented in animals that experienced social adversity. Concerning genotype, homozygous 5-HTT knockout mice were more anxious and less aggressive than heterozygous 5-HTT knockout and wildtype mice. In summary, adolescence is clearly an important phase in which anxiety-like and aggressive behavior can be shaped. Furthermore, it seems that having to cope with challenge during adolescence instead of experiencing throughout beneficial social conditions leads to reduced levels of anxiety-like behavior.
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Essential hypertension (EH) is a complex, polygenic condition with no single causative agent. Despite advances in our understanding of the pathophysiology of EH, hypertension remains one of the world's leading public health problems. Furthermore, there is increasing evidence that epigenetic modifications are as important as genetic predisposition in the development of EH. Indeed, a complex and interactive genetic and environmental system exists to determine an individual's risk of EH. Epigenetics refers to all heritable changes to the regulation of gene expression as well as chromatin remodelling, without involvement of nucleotide sequence changes. Epigenetic modification is recognized as an essential process in biology, but is now being investigated for its role in the development of specific pathologic conditions, including EH. Epigenetic research will provide insights into the pathogenesis of blood pressure regulation that cannot be explained by classic Mendelian inheritance. This review concentrates on epigenetic modifications to DNA structure, including the influence of non-coding RNAs on hypertension development.
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Job strain results from a combination of high workload and few decision-making opportunities in the workplace. There is inconsistent evidence regarding the association between job strain and hypertension, and methodological shortcomings preclude firm conclusions. Thus, a meta-analysis of observational studies on hypertension among occupational groups was conducted to determine whether job strain was associated with hypertension. In January 2012, we carried out a comprehensive, topic-specific electronic literature search of the Ovid MEDLINE, EMBASE and PsychoINFO databases complemented by individual help from non-communicable disease experts. Experimental/interventional studies and studies on personality disorders were excluded. Nine of 894 identified studies met the eligibility criteria and were included in the meta-analysis. The pooled OR of the nine studies was 1.3 (95% CI 1.14 to 1.48; p<0.001), of case-control studies 3.17 (95% CI 1.79 to 5.60; p<0.001) and of cohort studies 1.24 (95% CI 1.09 to 1.41; p<0.001), all of which indicated statistically significant positive associations between job strain and hypertension. In a subgroup analysis, cohort studies of good methodological quality showed significant associations between job strain and hypertension, while those of poor methodological quality showed no association or subgroup differences. We conclude that despite methodological differences, case-control and cohort studies of good methodological quality showed positive associations between hypertension and job strain.
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Despite having identified key physiological and behavioral risk factors, the prevalence of hypertension continues to rise, affecting two thirds of American adults 60 years or older. An important condition in its own right, hypertension is also a leading risk factor for cardiovascular diseases; thus, identifying additional modifiable determinants remains a public health priority. Psychological states and negative emotions more specifically have been proposed as risk factors, but the research findings are inconsistent. Additional prospective studies have recently been published increasing the availability of longitudinal data. The aim of this literature review is to evaluate these findings focusing on those from the last 3 years. We synthesize current research on whether negative (e.g., depression, anxiety) or positive (e.g., optimism) emotion-related factors are associated with high blood pressure onset. We discuss discrepant findings and propose considering emotion regulation as a novel approach to explain inconsistencies. Finally, we provide thoughts on future research directions.
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Epidemiological studies have repeatedly investigated the association between anxiety and hypertension. However, the results have been inconsistent. This study aimed to summarize the current evidence from cross-sectional and prospective studies that evaluated this association. Seven common databases were searched for articles published up to November 2014. Cross-sectional and prospective studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratios or hazard ratios, and 95% confidence intervals (CIs) were extracted or calculated by the authors. The pooled odds ratio was calculated separately for cross-sectional and prospective studies using random-effects models. The Q test and I2 statistic was used to assess heterogeneity. A funnel plot and modified Egger linear regression test were used to estimate publication bias. The search yielded 13 cross-sectional studies (n=151,389), and the final pooled odds ratio was 1.18 (95% CI 1.02-1.37; P Q<0.001; I (2)=84.9%). Eight prospective studies with a total sample size of 80,146 and 2,394 hypertension case subjects, and the pooled adjusted hazard ratio was 1.55 (95% CI 1.24-1.94; P Q<0.001; I (2)=84.6%). The meta-regression showed that location, diagnostic criteria for anxiety, age, sex, sample size, year of publication, quality, and years of follow-up (for prospective study) were not sources of heterogeneity. Our results suggest that there is an association between anxiety and increased risk of hypertension. These results support early detection and management of anxiety in hypertensive patients.
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Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent associations between exposure to discrimination and a wide range of Diagnostic and Statistical Manual of Mental Disorders (DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial/ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities", and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy. Expected final online publication date for the Annual Review of Clinical Psychology Volume 11 is March 28, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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A growing body of research demonstrates that psychosocial factors play an important role in the development of hypertension. Previous reviews have identified several key factors (i.e., occupational stress) that contribute to the onset of hypertension; however, they are now outdated. In this review, we provide an updated synthesis of the literature from 2010 to April 2014. We identified 21 articles for inclusion in the review, of which there were six categories of psychosocial stressors: occupational stress, personality, mental health, housing instability, social support/isolation, and sleep quality. Sixteen of the studies reported an association between the psychosocial stressor and blood pressure. While several findings were consistent with previous literature, new findings regarding mediating and moderating factors underlying the psychosocial-hypertension association help to untangle inconsistencies reported in the literature. Moreover, sleep quality is a novel additional factor that should undergo further exploration. Areas for future research based on these findings are discussed.
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Previous studies have shown that psychological well being is associated with reduced risk of cardiovascular disease. However, whether well being might be specifically associated with reduced risk of hypertension has not been rigorously investigated in prospective studies. This study examined the prospective association between two measures of psychological well being and incident hypertension. Participants were 6384 healthy British civil servants aged 39-63 from the Whitehall II cohort. Psychological well being (emotional vitality and optimism) and cardiovascular risk factors (demographic characteristics, health status, health behaviors, psychological ill being) were assessed during the 1991-1994 baseline. Incident hypertension was defined by clinical measures of SBP or DBP at least 140/90 mmHg, self-reported physician-diagnosed hypertension, or treatment for hypertension. Follow-up assessments of hypertension took place approximately every 3 years through 2002-2004. Cox proportional hazards regression models estimated hazard ratios. There were 2304 cases of incident hypertension during the follow-up period. High versus low emotional vitality was associated with a significantly reduced risk of hypertension in an age-adjusted model (hazard ratio = 0.89; 95% confidence interval 0.80-0.98). This association was maintained after controlling for demographic characteristics and health status, but was slightly attenuated after adjusting for health behaviors and ill being. Optimism was not significantly associated with hypertension. High emotional vitality was associated with reduced hypertension risk; favorable health behaviors explained only part of the relationship. Associations did not differ by age, were similar for men and women, and were maintained after accounting for ill being.
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Objectives Research about work-related stressors and cardiovascular disease (CVD) has produced mixed findings. Moreover, a paucity of data exists regarding the long-term associations between job strain and job insecurity and CVD among women.Methods We used Cox proportional hazard models to examine the relationship between job strain, job insecurity, and incident CVD over 10 years of follow-up among 22,086 participants in the Women’s Health Study (mean age 57±5 years).ResultsDuring 10 years of follow-up there were 170 myocardial infarctions (MI), 163 ischemic strokes, 440 coronary revascularizations, and 52 CVD deaths. In models adjusted for age, race, education, and income, women with high job strain (high demand, low control) were 38% more likely to experience a CVD event than their counterparts who reported low job strain (low demand, high control; Rate Ratio (RR) = 1.38, 95% Confidence Interval (CI) = 1.08–1.77), and women with active jobs (high demand, high control) were 38% more likely to experience a CVD event relative to women who reported low job strain (95% CI = 1.07–1.77). Outcome-specific analyses revealed that high job strain predicted non-fatal myocardial infarction (RR = 1.67, CI = 1.04–2.70), and coronary revascularization (RR = 1.41, CI = 1.05–1.90). No evidence of an association between job insecurity and long-term CVD risk was observed.Conclusion High strain and active jobs, but not job insecurity, were related to increased CVD risk among women. Both job strain and job insecurity were significantly related to CVD risk factors. With the increase of women in the workforce, these data emphasize the importance of addressing job strain in CVD prevention efforts among working women.
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The John Henryism (JH) hypothesis argues that prolonged high-effort coping with chronic psychosocial stressors may be associated with elevated risk for negative health outcomes among those without sufficient socioeconomic resources. Early JH studies found a significant association between high JH, low socioeconomic status, and hypertension among African-Americans. More recently, these findings have been extended to a wide array of health status outcomes, including cardiovascular reactivity, neurohormonal secretion, and negative health behaviors. The present review provides a comprehensive overview of JHs conceptual bases and empirical support. Limitations of the construct are discussed and recommendations are made to guide future theoretical and research efforts in the area.
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We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985-2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case-control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies. Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association. Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions. (Am J Public Health. Published online ahead of print January 17, 2013: e1-e11. doi:10.2105/AJPH.2012.301153).
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Background Hotel employees have higher rates of occupational injury and sustain more severe injuries than most other service workers.MethodOSHA log incidents from five unionized hotel companies for a three-year period were analyzed to estimate injury rates by job, company, and demographic characteristics. Room cleaning work, known to be physically hazardous, was of particular concern.ResultsA total of 2,865 injuries were reported during 55,327 worker-years of observation. The overall injury rate was 5.2 injuries per 100 worker-years. The rate was highest for housekeepers (7.9), Hispanic housekeepers (10.6), and about double in three companies versus two others. Acute trauma rates were highest in kitchen workers (4.0/100) and housekeepers (3.9/100); housekeepers also had the highest rate of musculoskeletal disorders (3.2/100). Age, being female or Hispanic, job title, and company were all independently associated with injury risk.Conclusion Sex- and ethnicity-based disparities in injury rates were only partially due to the type of job held and the company in which the work was performed. Am. J. Ind. Med. 53:116–125 2010. © 2009 Wiley-Liss, Inc.
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Job strain has been associated with hypertension among younger workers; however, whether this relationship persists among older workers, particularly older racial/ethnic minorities, is unresolved. This study evaluated whether job strain and workplace discrimination are associated with hypertension and poor blood pressure control among older workers and whether these relationships vary by gender and race/ethnicity. Data were drawn from the Health and Retirement Study, and analysis was restricted to employed participants with complete information on job strain and blood pressure (N = 3,794). In adjusted models, high job strain was associated with lower likelihood of hypertension (odds ratio (OR): 0.75, 95% confidence interval (CI): 0.63, 0.89) relative to low job strain. Stratified analyses indicated this association was only significant among white (OR: 0.71, 95% CI: 0.58, 0.86) and male (OR: 0.61, 95% CI: 0.47, 0.79) workers. High job strain was not significantly associated with hypertension among African American (OR: 1.14, 95% CI: 0.63, 2.07) or Hispanic (OR: 0.56, 95% CI: 0.29, 1.09) workers. Workplace discrimination was not associated with hypertension among any group. Neither job strain nor discrimination was associated with poor blood pressure control. These findings suggest that persistence in work characterized by high job strain in later life may signal resilience to the influence of work-related stressors on health. Future research efforts should examine the factors that contribute to gender and racial differences in these relationships.
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The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes. From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where <10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA(1c)). As part of our long-term survey, we obtained data on body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) for 84.2% of participants and data on glycated hemoglobin level for 71.3% of participants. Response rates were similar across randomized groups. The prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points (95% confidence interval [CI], -8.54 to -0.69), 3.38 percentage points (95% CI, -6.39 to -0.36), and 4.31 percentage points (95% CI, -7.82 to -0.80), respectively. The differences between the group receiving traditional vouchers and the control group were not significant. The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes. The mechanisms underlying these associations remain unclear but warrant further investigation, given their potential to guide the design of community-level interventions intended to improve health. (Funded by HUD and others.).
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To examine the effects of perceived racism and acculturation on the hypertension status of Native Hawaiians. Cross-sectional data from 94 Native Hawaiian adults were obtained which included the following: 1) socio-demographic variables and self-reported hypertension status; 2) a 5-item Hawaiian cultural identity subscale (HCSS) and a 5-item American cultural identity subscale (ACSS); and 3) perceived racism based on a 6-item modified version of the 32-item Oppression Questionnaire (OQ). Based on logistic regression analysis, the ACSS scores and OQ scores had significant (p<.05) and independent effects on hypertension status, after considering the effects of age, sex, and education level, and HCSS scores. Of the variables examined, OQ scores had the greatest magnitude of effect on hypertension status. More perceived racism and a greater identification with the American mainstream culture were both, independently, related to self-reported hypertension in Native Hawaiians. These findings have important clinical and public health implications.
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Despite improved hypertension (HTN) awareness and treatment, racial disparities in HTN prevalence persist. An understanding of the biopsychosocial determinants of HTN is necessary to address racial disparities in the prevalence of HTN. This review examines the evidence directly and indirectly linking multiple levels of racism to HTN. Published empirical research in EBSCO databases investigating the relationships of three levels of racism (individual/interpersonal, internalized, and institutional racism) to HTN was reviewed. Direct evidence linking individual/interpersonal racism to HTN diagnosis is weak. However, the relationship of individual/interpersonal racism to ambulatory blood pressure (ABP) is more consistent, with all published studies reporting a positive relationship of interpersonal racism to ABP. There is no direct evidence linking internalized racism to BP. Population-based studies provide some evidence linking institutional racism, in the forms of residential racial segregation (RRS) and incarceration, to HTN incidence. Racism shows associations to stress exposure and reactivity as well as associations to established HTN-related risk factors including obesity, low levels of physical activity and alcohol use. The effects vary by level of racism. Overall the findings suggest that racism may increase risk for HTN; these effects emerge more clearly for institutional racism than for individual level racism. All levels of racism may influence the prevalence of HTN via stress exposure and reactivity and by fostering conditions that undermine health behaviors, raising the barriers to lifestyle change.
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Stereotype threat spillover is a situational predicament in which coping with the stress of stereotype confirmation leaves one in a depleted volitional state and thus less likely to engage in effortful self-control in a variety of domains. We examined this phenomenon in 4 studies in which we had participants cope with stereotype and social identity threat and then measured their performance in domains in which stereotypes were not "in the air." In Study 1 we examined whether taking a threatening math test could lead women to respond aggressively. In Study 2 we investigated whether coping with a threatening math test could lead women to indulge themselves with unhealthy food later on and examined the moderation of this effect by personal characteristics that contribute to identity-threat appraisals. In Study 3 we investigated whether vividly remembering an experience of social identity threat results in risky decision making. Finally, in Study 4 we asked whether coping with threat could directly influence attentional control and whether the effect was implemented by inefficient performance monitoring, as assessed by electroencephalography. Our results indicate that stereotype threat can spill over and impact self-control in a diverse array of nonstereotyped domains. These results reveal the potency of stereotype threat and that its negative consequences might extend further than was previously thought.
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An attenuation of the nighttime decline in blood pressure (BP) predicts cardiovascular disease and cardiovascular-related mortality, beyond daytime BP levels. We investigated whether positive and negative psychological attributes were associated with sleep-wake BP ratios and examined sleep parameters as potential mediators of these relationships. Two hundred twenty-four participants (50% men; 43% Black; mean age = 60 years) underwent ambulatory BP monitoring for 2 days and nights. Self-reports of positive and negative psychological attributes were collected. In-home polysomnography was conducted for 2 nights, and a wrist actigraph was worn for 9 nights. Sleep-wake mean arterial pressure (MAP) ratios. After adjustment for demographics, body mass index, and hypertensive status, low life purpose and high hostility were associated with high sleep-wake MAP ratios. Depression, anxiety, and optimism were not related to MAP ratios. Sleep latency, fragmentation, architecture, and the apnea-hypopnea index were examined as potential mediators between psychological attributes and MAP ratios; only long sleep latency mediated the relationship between hostility and MAP ratios. Low life purpose and high hostility are associated with high sleep-wake BP ratios in Black and White adults, and these relationships are largely independent of sleep.
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Social support is an important determinant of health, yet understanding of its contribution to racial disparities in hypertension is limited. Many studies have focused on the relationship between hypertension and social support, or race/ethnicity and social support, but few have examined the inter-relationship between race/ethnicity, social support, and hypertension. The objective of this study was to determine whether the relationship between race/ethnicity and hypertension varied by level of social support. Data from the National Health and Nutrition Examination Survey (NHANES) 2001-2006 were used to calculate the odds ratios (ORs) for the association between hypertension and race/ethnicity by levels of social support. Hypertension was defined as systolic blood pressure (BP) >or=140 mm Hg and/or diastolic BP >or=90 mm Hg or having been prescribed antihypertensive medication. Social support was defined by emotional and financial support, and marital status. Black/white ORs of hypertension increased as social support decreased; that is, the race difference among those without social support was larger compared to those with social support. Contrarily, Mexican American/white ethnic differences were only observed among those with social support; Mexican Americans with social support had lower odds of hypertension than their white counterparts. This study observed that the relationship between race (but not ethnicity) and hypertension varies by social support level. Results suggest there may be beneficial effects of social support on hypertension among blacks, however, the possible impact of social support on ethnic differences in hypertension remains unclear.
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Incarceration is associated with increased cardiovascular disease mortality, but prospective studies exploring mechanisms of this association are lacking. We examined the independent association of prior incarceration with incident hypertension, diabetes, and dyslipidemia using the Coronary Artery Risk Development in Young Adults (CARDIA) study-a cohort of young adults aged 18 to 30 years at enrollment in 1985-1986, balanced by sex, race (black and white), and education (high school education or less). We also examined the association of incarceration with left ventricular hypertrophy on echocardiography and with barriers to health care access. Of 4350 participants, 288 (7%) reported previous incarceration. Incident hypertension in young adulthood was more common among former inmates than in those without incarceration history (12% vs 7%; odds ratio, 1.7 [95% confidence interval {CI}, 1.2-2.6]), and this association persisted after adjustment for smoking, alcohol and illicit drug use, and family income (adjusted odds ratio [AOR], 1.6 [95% CI, 1.0-2.6]). Incarceration was significantly associated with incident hypertension in those groups with the highest prevalence of prior incarceration, ie, black men (AOR, 1.9 [95% CI, 1.1-3.5]) and less-educated participants (AOR, 4.0 [95% CI, 1.0-17.3]). Former inmates were more likely to have left ventricular hypertrophy (AOR, 2.7, [95% CI, 0.9-7.9]) and to report no regular source for medical care (AOR, 2.5, [95% CI, 1.3-4.8]). Cholesterol levels and diabetes rates did not differ by history of incarceration. Incarceration is associated with future hypertension and left ventricular hypertrophy among young adults. Identification and treatment of hypertension may be important in reducing cardiovascular disease risk among formerly incarcerated individuals.
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BACKGROUND Research that examines the associations of psychosocial factors with incident hypertension among African Americans (AA) is limited. Using Jackson Heart Study (JHS) data, we examined associations of negative affect and stress with incident hypertension and blood pressure (BP) progression among AA. METHODS Our sample consisted of 1,656 normotensive participants at baseline (2000–2004) (mean age 47±12; 61% women). We investigated associations of negative affect (cynical distrust, anger-in, anger-out, and depressive symptoms) and stress (perceived stress, weekly stress inventory (WSI)-event, WSI-impact, and major life events) with BP progression (an increase by one BP stage as defined by JNC VII) and incident hypertension by examination 2 (2005–2008). Poisson regression analysis was utilized to examine the prevalence ratios (PRs; 95% confidence interval (CI)) of BP tracking and incident hypertension with psychosocial factors, adjusting for baseline age, sex, socioeconomic status (SES), and hypertension risk factors. RESULTS Fifty-six percentage of the sample (922 cases) had BP progression from 2005 to 2008. After adjustment for age, sex, and SES, a high anger-out score was associated with a 20% increased risk of BP progression compared to a low anger-out score (PR 1.20; 95% CI 1.05–1.36). High depressive symptoms score was associated with BP progression in the age, sex, and SES-adjusted model (PR 1.14; 95% CI 1.00–1.30). High WSI-event scores were associated with BP progression in the fully adjusted model (PR 1.21; 95% CI 1.04–1.40). We did not observe significant associations with any of the psychosocial measures and incident hypertension. CONCLUSIONS Psychosocial factors were associated with BP progression, with the strongest evidence for number of stressful events that occurred.
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Childhood adversity is a risk factor for adult health outcomes, including obesity and hypertension. This study examines whether childhood adversity predicted mean arterial pressure through mechanisms of central obesity and leptin, adiponectin, and/or insulin resistance, and including dietary quality. 210 Black/African Americans and White/European Americans, mean age = 45.8; ±3.3 years, were studied cross-sectionally. Path analyses were used to specify a chain of predictive variables in which childhood adversity predicted waist–hip ratio and dietary quality, circulating levels of hormones, and in turn, mean arterial pressure, adjusting for race, gender, and antihypertensive medications. Direct paths were found between childhood adversity, waist–hip ratio, and leptin levels and between leptin and dietary quality to mean arterial pressure. Systolic and diastolic blood pressures were similarly predicted. Early adversity appears to developmentally overload and dysregulate endocrine systems through increased risk for obesity, and through a direct impact on leptin that in turn, impacts blood pressure.
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A general theory of domain identification is used to describe achievement barriers still faced by women in advanced quantitative areas and by African Americans in school. The theory assumes that sustained school success requires identification with school and its subdomains; that societal pressures on these groups (e.g., economic disadvantage, gender roles) can frustrate this identification; and that in school domains where these groups are negatively stereotyped, those who have become domain identified face the further barrier of stereotype threat, the threat that others' judgments or their own actions will negatively stereotype them in the domain. Research shows that this threat dramatically depresses the standardized test performance of women and African Americans who are in the academic vanguard of their groups (offering a new interpretation of group differences in standardized test performance), that it causes disidentification with school, and that practices that reduce this threat can reduce these negative effects.
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Dietary patterns consider synergistic effects compared with isolated foods or nutrients on health outcomes. The aim of this systematic review and meta-analysis was to examine the associations of diet quality as assessed by the Healthy Eating Index (HEI), the Alternate Healthy Eating Index (AHEI), and the Dietary Approaches to Stop Hypertension (DASH) score and the risk of all-cause mortality, cardiovascular mortality or incidence, cancer mortality or incidence, type 2 diabetes mellitus, and neurodegenerative diseases. A literature search was performed using the electronic databases MEDLINE, SCOPUS, and EMBASE with an end date of May 10, 2014. Study-specific risk ratios were pooled using a random effect model by the Cochrane software package Review Manager 5.2. Fifteen cohort studies (34 reports), including 1,020,642 subjects, met the criteria and were included in the meta-analysis. Diets of the highest quality, as assessed by the HEI, AHEI, and DASH score, resulted in a significant risk reduction (RR) for all-cause mortality (RR 0.78, 95% CI 0.76 to 0.80; P<0.00001; I(2)=61%, 95% CI 20% to 81%), cardiovascular disease (incidence or mortality) (RR 0.78, 95% CI 0.75 to 0.81; P<0.00001; I(2)=45%, 95% CI 13% to 66%), cancer (incidence or mortality) (RR 0.85, 95% CI 0.82 to 0.88; P<0.00001; I(2)=77%, 95% CI 68% to 84%), and type 2 diabetes mellitus (RR 0.78, 95% CI 0.72 to 0.85; P<0.00001; I(2)=74%, 95% CI 52% to 86%). Differences observed for neurodegenerative diseases were not significant. Egger regression tests provided no evidence of publication bias. Diets that score highly on the HEI, AHEI, and DASH are associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, and type 2 diabetes mellitus by 22%, 22%, 15%, and 22%, respectively, and therefore is of high public health relevance. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
Article
An increasing body of literature indicates that discrimination has a negative impact on health; poor sleep may be an underlying mechanism. The primary objective of this review was to examine existing studies on the relationship between discrimination and sleep to clarify (a) the potential role of discrimination in shaping population patterns of sleep and sleep disparities, and (b) the research needed to develop interventions at individual and institutional levels. We identified articles from English-language publications in PubMed and EBSCO databases from inception through July 2014. We employed a broad definition of discrimination to include any form of unfair treatment and all self-reported and objectively assessed sleep outcomes, including duration, difficulties, and sleep architecture. Seventeen studies were identified: four prospective, 12 cross-sectional, and one that utilized a daily-diary design. Fifteen of the 17 studies evaluated interpersonal discrimination as the exposure and the majority of studies included self-reported sleep as the outcome. Only four studies incorporated objective sleep assessments. All 17 studies identified at least one association between discrimination and a measure of poorer sleep, although studies with more detailed consideration of either discrimination or sleep architecture revealed some inconsistencies. Taken together, existing studies demonstrate consistent evidence that discrimination is associated with poorer sleep outcomes. This evidence base can be strengthened with additional prospective studies that incorporate objectively measured aspects of sleep. We outline important extensions for this field of inquiry that can inform the development of interventions to improve sleep outcomes, and consequently promote well-being and reduce health inequities across the life course. Copyright © 2015 Elsevier B.V. All rights reserved.
Article
The relationship between socioeconomic status (SES) and hypertension has been studied in a number of reviews. However, the impact of SES on hypertension has been reported in several studies with conflicting results. A systematic search was performed in PubMed, Proquest and Cochrane databases for observational studies on hypertension prevalence and SES, published in English, until March 2014. Hypertension was defined as a mean SBP of at least 140 mmHg or a DBP of at least 90 mmHg, or use of antihypertensive medication. The inverse variance method with a random-effects model was used to pool the risk estimates from the individual studies. Data abstraction was conducted independently by two authors. Among the 2404 references, 51 studies fulfilled the inclusion criteria. An overall increased risk of hypertension among the lowest SES was found for all three indicators: income [pooled odds ratio (OR) 1.19, 95% confidence interval (CI) 0.96-1.48], occupation (pooled OR 1.31, 95% CI 1.04-1.64) and education (pooled OR 2.02, 95% CI 1.55-2.63). The associations were significant in high-income countries, and the increased risk of hypertension for the lowest categories of all SES indicators was most evident for women, whereas men revealed less consistent associations. Low SES is associated with higher blood pressure, and this association is particularly evident in the level of education. It is important to identify and monitor hypertension to reduce the risk of this disease among the most vulnerable groups in different countries and among different societies.
Article
Objective: We examined the association between childhood adversity and cumulative biological risk for a variety of chronic diseases in adulthood, and whether this association varied by neighborhood affluence. Methods: Data were drawn from the Chicago Community Adult Health Study (2001-2003), a cross-sectional probability sample that included interviews and blood collection (n = 550 adults). A childhood adversity score was calculated from eight items. Neighborhood affluence was defined using Census data. An index to reflect cumulative biological risk was constructed as a count of eight biomarkers above clinically established thresholds, including systolic and diastolic blood pressure, resting heart rate, C-reactive protein, waist circumference, hemoglobin A1c, and total and high-density lipoprotein cholesterol. Generalized linear models with a Poisson link function were used to estimate incident rate ratios (IRRs). Results: A 1-standard-deviation increase in the childhood adversity score was associated with a 9% increase in cumulative biological risk, after adjustment for demographic and behavioral characteristics (IRR = 1.09, 95% confidence interval (CI) = 1.02-1.17). This association was modified by neighborhood affluence (IRR = 0.92, 95% CI = 0.86, 0.99). Stratified models indicated that childhood adversity was associated with elevated cumulative biological risk only among individuals who resided in low-affluence (bottom tertile) neighborhoods (IRR = 1.16, 95% CI = 1.05, 1.28); there was no association in high-affluence (top tertile) neighborhoods (IRR = 0.97, 95% CI = 0.83, 1.14). Conclusions: Childhood adversity is associated with elevated cumulative biological risk in adulthood, and neighborhood affluence may buffer this association. Results demonstrate the importance of neighborhood characteristics for associations between childhood adversity and disease risk, even after accounting for adult socioeconomic status.
Article
Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluated in regard to their potential blood pressure-lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone fewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure-lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. Among behavioral therapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), other relaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidence demonstrating their efficacy. Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support than acupuncture (Class III, Level of Evidence B). Exercise-based regimens, including aerobic (Class I, Level of Evidence A), dynamic resistance (Class IIA, Level of Evidence B), and isometric handgrip (Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mmHg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate. A suggested management algorithm is provided, along with recommendations for prioritizing the use of the individual approaches in clinical practice based on their level of evidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. Finally, recommendations for future research priorities are outlined.
Article
Objective: Discrimination is posited to underlie racial disparities in hypertension. Extant literature suggests a possible association between racial discrimination and blood pressure, although inconsistent findings have been reported. The aim of this comprehensive systematic review was to quantitatively evaluate the association between perceived racial discrimination with hypertensive status and systolic, diastolic, and ambulatory blood pressure. Method: Electronic database search of PubMed and PsycINFO (keywords: blood pressure/hypertension/diastolic/systolic, racism/discrimination/prejudice/unfair treatment) was combined with descendancy and ascendancy approaches. Forty-four articles (N = 32,651) met inclusion criteria. Articles were coded for demographics, hypertensive diagnosis, blood pressure measurement, discrimination measure and constructs, study quality, and effect sizes. Results: Random effects meta-analytic models were tested based on Fisher's Z, the derived common effect size metric. Overall, perceived racial discrimination was associated with hypertensive status, Zhypertension = 0.048, 95% CI [.013, .087], but not with resting blood pressure, Zsystolic = 0.011, 95% CI [-.006, .031], Zdiastolic = .016, 95% CI [-.006, .034]. Moderators that strengthened the relation included sex (male), race (Black), age (older), education (lower), and hypertensive status. Perceived discrimination was most strongly associated with nighttime ambulatory blood pressure, especially among Blacks. Conclusions: Despite methodological limitations in the existing literature, there was a small, significant association between perceived discrimination and hypertension. Future studies should consider ambulatory nighttime blood pressure, which may more accurately capture daily variation attributable to experienced racial discrimination. Perceived discrimination may partly explain racial health disparities.
Article
Objectives: We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults. Methods: We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n = 3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models. Results: Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range = 0-12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR = 1.05; 95% CI = 0.99, 1.12), and Whites showed no association (OR = 0.95; 95% CI = 0.87, 1.03). Conclusions: Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.
Article
This article reviews the empirical evidence that suggests that there is a solid foundation for more systematic research attention to the ways in which interventions that seek to reduce the multiple dimensions of racism can improve health and reduce disparities in health. First, research reveals that policies and procedures that seek to reduce institutional racism by improving neighborhood and educational quality and enhancing access to additional income, employment opportunities, and other desirable resources can improve health. Second, research is reviewed that shows that there is the potential to improve health through interventions that can reduce cultural racism at the societal and individual level. Finally, research is presented that suggests that the adverse consequences of racism on health can be reduced through policies that maximize the health-enhancing capacities of medical care, address the social factors that initiate and sustain risk behaviors, and empower individuals and communities to take control of their lives and health. Directions for future research are outlined.
Article
This article reviews the scientific research that indicates that despite marked declines in public support for negative racial attitudes in the United States, racism, in its multiple forms, remains embedded in American society. The focus of the article is on the review of empirical research that suggests that racism adversely affects the health of nondominant racial populations in multiple ways. First, institutional racism developed policies and procedures that have reduced access to housing, neighborhood and educational quality, employment opportunities, and other desirable resources in society. Second, cultural racism, at the societal and individual level, negatively affects economic status and health by creating a policy environment hostile to egalitarian policies, triggering negative stereotypes and discrimination that are pathogenic and fostering health-damaging psychological responses, such as stereotype threat and internalized racism. Finally, a large and growing body of evidence indicates that experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioral patterns that increase health risks.
Article
The experience of racial discrimination among African Americans may contribute to an increased risk of developing hypertension and having poor hypertension control once diagnosed. Although it is a commonly held belief that experiences of discrimination may exert lasting effects on health behavior and physiology, the existing evidence is mixed. The objective of this review was to identify evidence linking the experience of discrimination with hypertension among African Americans and to provide an updated synthesis of the literature. Articles for the review were identified through an electronic search of PubMed, OVID, and other pertinent journals. The review was augmented with a manual search of references. We assessed the quality of included articles using modified Downs and Black criteria. In total, 15 articles were selected for the review, 12 cross-sectional studies and 3 cohort studies. The preponderance of evidence (9 of 15 articles) indicated that discrimination was associated with an increased risk of developing hypertension, difficulty obtaining control of existing hypertension, and/or elevated blood pressure among those without a diagnosis of hypertension. This systematic review supports the association of racial discrimination with an increased risk of developing hypertension; however, the picture is not uniform. Methodological challenges, such as floor or ceiling effects of reported discrimination and low sample size, may have prevented researchers from detecting important associations. A better understanding of the emerging but complex relationship between discrimination and hypertension among African Americans is needed, as we seek to resolve existing cardiovascular health disparities.
Article
Objectives Empirical findings on racial discrimination and hypertension risk have been inconsistent. Some studies have found no association between self-reported experiences of discrimination and cardiovascular health outcomes, whereas others have found moderated or curvilinear relationships. The current cross-sectional study examined whether the association between racial discrimination and hypertension is moderated by implicit racial bias among African American midlife men.Methods This study examined the data on 91 African American men between 30 and 50 years of age. Primary variables were self-reported experiences of racial discrimination and unconscious racial bias as measured by the Black-White Implicit Association Test. Modified Poisson regression models were specified, examining hypertension, defined as a mean resting systolic level of at least 140 mm Hg or diastolic level of at least 90 mm Hg, or self-reported history of cardiovascular medication use with a physician diagnosis of hypertension.ResultsNo main effects for discrimination or implicit racial bias were found, but the interaction of the two variables was significantly related to hypertension (χ(2)(1) = 4.89, p < .05). Among participants with an implicit antiblack bias, more frequent reports of discrimination were associated with a higher probability of hypertension, whereas among those with an implicit problack bias, it was associated with lower risk.Conclusions The combination of experiencing racial discrimination and holding an antiblack bias may have particularly detrimental consequences on hypertension among African American midlife men, whereas holding an implicit problack bias may buffer the effects of racial discrimination. Efforts to address both internalized racial bias and racial discrimination may lower cardiovascular risk in this population.
Article
Despite the widespread assumption that racial differences in stress exist and that stress is a key mediator linking racial status to poor health, relatively few studies have explicitly examined this premise. We examine the distribution of stress across racial groups and the role of stress vulnerability and exposure in explaining racial differences in health in a community sample of Black, Hispanic, and White adults, employing a modeling strategy that accounts for the correlation between types of stressors and the accumulation of stressors in the prediction of health outcomes. We find significant racial differences in overall and cumulative exposure to eight stress domains. Blacks exhibit a higher prevalence and greater clustering of high stress scores than Whites. American-born Hispanics show prevalence rates and patterns of accumulation of stressors comparable to Blacks, while foreign-born Hispanics have stress profiles similar to Whites. Multiple stressors correlate with poor physical and mental health, with financial and relationship stressors exhibiting the largest and most consistent effects. Though we find no support for the stress-vulnerability hypothesis, the stress-exposure hypothesis does account for some racial health disparities. We discuss implications for future research and policy.
Article
To contribute to the growing understanding of U.S. black-white health disparities by examining psychosocial stress as an important contributor to physical health problems. Data are from the National Survey of American Life, an integrated national household probability sample of White Americans, African Americans, and Caribbean blacks. Regression analysis was used to assess associations between goal-striving stress and hypertension, BMI, physical health problems, and self-rated health. After accounting for sociodemographic factors and three additional stressors--personal problems, lifetime racial discrimination, and everyday racial discrimination-goal-striving stress was a significant predictor of hypertension, physical health problems, and diminished self-rated health. Ethnicity moderated the relationship; the negative association between goal-striving stress and physical health problems was strongest for Caribbean blacks. This study extends the research on goal-striving stress and adds to a growing literature documenting relationships between social processes and disease.
Article
This review investigates the association between positive psychological well-being (PPWB) and cardiovascular disease (CVD). We also consider the mechanisms by which PPWB may be linked with CVD, focusing on the health behaviors (e.g., smoking, alcohol consumption, physical activity, sleep quality and quantity, and food consumption) and biological functions (e.g., cardiovascular, inflammatory, and metabolic processes) that are most relevant for cardiovascular health. Because PPWB is a broad concept, not all aspects of PPWB may be associated with cardiovascular health. Thus, we distinguish between eudaimonic well-being, hedonic well-being, optimism, and other measures of well-being when reviewing the literature. Findings suggest that PPWB protects consistently against CVD, independently of traditional risk factors and ill-being. Specifically, optimism is most robustly associated with a reduced risk of cardiovascular events. In general, PPWB is also positively associated with restorative health behaviors and biological function and inversely associated with deteriorative health behaviors and biological function. Cardiovascular health is more consistently associated with optimism and hedonic well-being than with eudaimonic well-being, although this could be due in part to more limited evidence being available concerning eudaimonic well-being. Some similarities were also evident across different measures of PPWB, which is likely due to measurement overlap. A theoretical context for this research is provided, and suggestions for future research are given, including the need for additional prospective investigations and research that includes multiple constructs of psychological well-being and ill-being.
Article
It has long been known that depression is associated with hypertension but whether depression is a risk factor for hypertension incidence is still inconclusive. To assess whether depression increases the incidence of hypertension. Literatures were searched from PubMed, EMBASE, Cochrane and PsycINFO without language restrictions. Any prospective cohort study was included, which reported the correlation between depression and incidence of hypertension in apparently healthy normotensive individuals. At baseline, the studies which had at least one self-report or interview-based assessment on depressive symptoms/disorders were selected. The definition of hypertension was defined as a repeatedly elevated blood pressure exceeding 140 (systolic) and/or over 90  mmHg (diastolic) determined in interview, use of antihypertensive medications, or self-reported or recorded diagnosed hypertension. Studies with cross-sectional or case-control design were excluded. Data abstraction was conducted independently by two authors. Seventy-five full texts were initially searched, but only nine studies met our inclusion criteria, and they were comprised of 22 367 participants with a mean follow-up period of 9.6 years. We found that depression increased the risk of hypertension incidence [adjusted relative risk 1.42, 95% confidence interval (CI) 1.09 to 1.86, P = 0.009] and the risk was significantly correlated with the length of follow-up (P = 0.0002) and the prevalence of depression at baseline (P < 0.0001). Our meta-analysis supports that depression is probably an independent risk factor of hypertension. It is important to take depression into consideration during the process of prevention and treatment of hypertension. Further studies are needed to exclude the effects of other confounding factors.
Article
Using Jackson Heart Study data, we examined whether perceived discrimination was associated with prevalent hypertension in African Americans. Everyday discrimination, lifetime discrimination, burden of discrimination, and stress from discrimination were examined among 4939 participants aged 35 to 84 years (women = 3123; men = 1816). We estimated prevalence ratios of hypertension by discrimination, and adjusted for age, gender, socioeconomic status, and risk factors. The prevalence of hypertension was 64.0% in women and 59.7% in men. After adjustment for age, gender, and socioeconomic status, lifetime discrimination and burden of discrimination were associated with greater hypertension prevalence (prevalence ratios for highest vs lowest quartile were 1.08 [95% confidence interval (CI) = 1.02, 1.15] and 1.09 [95% CI = 1.02,1.16] for lifetime discrimination and burden of discrimination, respectively). Associations were slightly weakened after adjustment for body mass index and behavioral factors. No associations were observed for everyday discrimination. Further understanding the role of perceived discrimination in the etiology of hypertension may be beneficial in eliminating hypertension disparities.
Article
Apolipoprotein L1 (APOL1) gene association studies and results of the African American Study of Kidney Disease and Hypertension are disproving the longstanding concept that mild to moderate essential hypertension contributes substantially to end-stage renal disease susceptibility in African Americans. APOL1 coding variants underlie a spectrum of kidney diseases, including that attributed to hypertension (labeled arteriolar or hypertensive nephrosclerosis), focal segmental glomerulosclerosis, and HIV-associated nephropathy. APOL1 nephropathy risk variants persist because of protection afforded from the parasite that causes African sleeping sickness. This breakthrough will lead to novel treatments for hypertensive African Americans with low-level proteinuria, for whom effective therapies are lacking. Furthermore, APOL1 nephropathy risk variants contribute to racially variable allograft survival rates after kidney transplantation and assist in detecting nondiabetic forms of nephropathy in African Americans with diabetes. Discovery of APOL1-associated nephropathy was a major success of the genetics revolution, demonstrating that secondary hypertension is typically present in nondiabetic African Americans with nephropathy.
Article
Occupational stress, or job strain, resulting from a lack of balance between job demands and job control, is considered one of the frequent factors in the etiology of hypertension in modern society. Stress, with its multifactorial causes, is complex and difficult to analyze at the physiological and psychosocial levels. The possible relation between job strain and blood pressure levels has been extensively studied, but the literature is replete with conflicting results regarding the relationship between the two. Further analysis of this relationship, including the many facets of job strain, may lead to operative proposals at the individual and public health levels designed to reduce the effects on health and well-being. In this article, we review the literature on the subject, discussing the various methodologies, confounding variables, and suggested approaches for a healthier work environment.