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Lewis TT, Parker R, Erving CL, Udaipuria S, Murden RJ, Fields ND, Booker B, Moore RH, Vaccarino V. Financial responsibility, financial context, and ambulatory blood pressure in early middle-aged African-American women. Soc Sci Med 2024; 345:116699. [PMID: 38412624 PMCID: PMC11014723 DOI: 10.1016/j.socscimed.2024.116699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/06/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND African-American women have excess rates of elevated blood pressure (BP) and hypertension compared to women of all other racial/ethnic backgrounds. Several researchers have speculated that race and gender-related socioeconomic status (SES) stressors might play a role. OBJECTIVE To examine the association between a novel SES-related stressor highly salient among African-American women, financial responsibility for one's household, and 48-h ambulatory BP. We further examined whether aspects related to African-American women's financial context (e.g., single parenthood, household income, marital status) played a role. METHODS Participants were N = 345 employed, healthy African-American women aged 30-46 from diverse SES backgrounds who underwent 48-h ambulatory BP monitoring. Linear regression analyses were conducted to examine associations between self-reported financial responsibility and daytime and nighttime BP, adjusting for age, SES and other sociodemographics, cardiovascular risk factors, financial strain and depressive symptoms. Interactions between financial responsibility and single parenthood, household income, and marital/partnered status were tested. RESULTS In age-adjusted analyses, reporting financial responsibility was associated with higher daytime systolic (β = 4.42, S.E. = 1.36, p = 0.0013), and diastolic (β = 2.82, S.E. = 0.98, p = 0.004) BP. Associations persisted in fully adjusted models. Significant associations were also observed for nighttime systolic and diastolic BP. There were no significant interactions with single parenthood, household income, nor marital/partnered status. CONCLUSION Having primary responsibility for one's household may be an important driver of BP in early middle-aged African-American women, independent of SES, financial strain, and across a range of financial contexts. Future studies examining prospective associations are needed, and policy interventions targeting structural factors contributing to financial responsibility in African-American women may be warranted.
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Affiliation(s)
- Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Rachel Parker
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christy L Erving
- Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Shivika Udaipuria
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Raphiel J Murden
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole D Fields
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bianca Booker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Reneé H Moore
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
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Tang A, Yang E, Ebinger JE. Non-Dipping Blood Pressure or Nocturnal Hypertension: Does One Matter More? Curr Hypertens Rep 2024; 26:21-30. [PMID: 37955827 PMCID: PMC10796526 DOI: 10.1007/s11906-023-01273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE OF REVIEW Nocturnal hypertension and non-dipping are both associated with increased cardiovascular risk; however, debate remains over which is a better prognosticator of cardiovascular outcomes. This review explores current literature on nocturnal hypertension and non-dipping to assess their relationship to cardiovascular disease and implications for clinical practice. RECENT FINDINGS While current data remain inconclusive, some suggest that nocturnal hypertension is a more reliable and clinically significant marker of cardiovascular risk than non-dipping status. Importantly, reducing nocturnal HTN and non-dipping through chronotherapy, specifically evening dosing of antihypertensives, has not been conclusively shown to provide long-term cardiovascular benefits. Recent data suggests that non-dipping, compared to nocturnal hypertension, may be falling out of favor as a prognostic indicator for adverse cardiovascular outcomes. However, additional information is needed to understand how aberrant nighttime blood pressure patterns modulate cardiovascular risk to guide clinical management.
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Affiliation(s)
- Amber Tang
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Eugene Yang
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Joseph E Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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3
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Lewis TT, Parker R, Murden R, Spikes T, Erving C, McKinnon II, Van Dyke ME, Booker B, Quyummi A, Vaccarino V, Moore RH. Network stressors, personal stressors, and ambulatory blood pressure in African-American women-Does superwoman schema play a role? Health Psychol 2023; 42:485-495. [PMID: 37338427 PMCID: PMC10361646 DOI: 10.1037/hea0001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Life stressors have been linked to cardiovascular risk; however, studies typically focus on stressors that directly impact the individual, that is, personal stressors. Research suggests that women, particularly African-American women, may be more vulnerable to network stressors that involve family members and friends-potentially due to norms around needing to be a "Superwoman." Yet few studies have examined these phenomena. METHOD We examined associations between network, versus personal, stressors, and elevated blood pressure (BP) in N = 392 African-American women aged 30-46. Questionnaire-assessed negative life events were classified into upsetting network or personal stressors. BP was assessed in clinic and via 48-hr ambulatory monitoring. Linear and logistic regression models examined associations between type of stressors and 48-hr daytime and nighttime systolic BP (SBP) and diastolic BP (DBP), and sustained hypertension after adjusting for relevant covariates. Interactions with questionnaire-assessed superwoman schema (SWS) were tested in exploratory analyses. RESULTS In age and sociodemographic-adjusted models, network stressors were significantly associated with daytime SBP, β (SE) = 2.01 (0.51), p ≤ .0001, and DBP, β (SE) = 1.59 (0.37), p ≤ .0001, but personal stressors were not (p values > .10). Associations persisted after adjustment for cardiovascular and psychosocial risk factors. Patterns were similar for nighttime BP and sustained hypertension. There were no interactions with SWS. CONCLUSIONS Network, but not personal, stressors were associated with elevated rates of daytime SBP and DBP, as well as sustained hypertension in African-American women, irrespective of SWS endorsement. Future research is needed to determine whether stress-management interventions focused on network stressors might impact BP in this high-risk population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rachel Parker
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Raphiel Murden
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Christy Erving
- Department of Sociology, The University of Texas at Austin, Austin, TX
| | - Izraelle I. McKinnon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Miriam E. Van Dyke
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Bianca Booker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Arshed Quyummi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Reneé H. Moore
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, PA
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Birmingham WC, Jorgensen A, Hancock S, Wadsworth LL, Hung M. Social Support: The Effect on Nocturnal Blood Pressure Dipping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054579. [PMID: 36901589 PMCID: PMC10001803 DOI: 10.3390/ijerph20054579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/13/2023]
Abstract
Social support has long been associated with cardiovascular disease risk assessed with blood pressure (BP). BP exhibits a circadian rhythm in which BP should dip between 10 and 15% overnight. Blunted nocturnal dipping (non-dipping) is a predictor of cardiovascular morbidity and mortality independent of clinical BP and is a better predictor of cardiovascular disease risk than either daytime or nighttime BP. However, it is often examined in hypertensive individuals and less often in normotensive individuals. Those under age 50 are at increased risk for having lower social support. This study examined social support and nocturnal dipping in normotensive individuals under age 50 using ambulatory blood pressure monitoring (ABP). ABP was collected in 179 participants throughout a 24-h period. Participants completed the Interpersonal Support Evaluation List, which assesses perceived levels of social support in one's network. Participants with low levels of social support demonstrated blunted dipping. This effect was moderated by sex, with women showing greater benefit from their social support. These findings demonstrate the impact social support can have on cardiovascular health, exhibited through blunted dipping, and are particularly important as the study was conducted in normotensive individuals who are less likely to have high levels of social support.
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Affiliation(s)
- Wendy C. Birmingham
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
- Correspondence:
| | - Anna Jorgensen
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
| | - Sinclaire Hancock
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
| | - Lori L. Wadsworth
- Romney Institute of Public Management, Brigham Young University, Provo, UT 84602, USA
| | - Man Hung
- Department of Orthopedic Surgery Operations, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- College of Dental Medicine, Roseman University of Health Sciences, 10894 S River Front Pkwy, South Jordan, UT 84095, USA
- George E. Wahlen Department of Veteran Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
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Horne CE, Stayt LC, Schutz S, Smith CM, Haberstroh A, Bolin LP, Taylor CL, Moosavi SH, Bibbey A. Symptom experiences in hypertension: a mixed methods systematic review. J Hypertens 2023; 41:1-16. [PMID: 36250472 DOI: 10.1097/hjh.0000000000003306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM Understanding patients' hypertension (HTN) symptoms can assist healthcare professionals' awareness of individual, cultural, and behavioral responses and improve diagnostic accuracy to optimize treatment. The purpose of this review was to evaluate and synthesize current literature exploring HTN symptoms. METHODS Databases searched included MEDLINE (PubMed), CINAHL (EBSCO), Scopus, and Web of Science from January 2010 to January 2022. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The McMaster critical review forms were used to determine the quality of both qualitative and quantitative articles. Synthesis of the data was guided by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews. RESULTS In total, 41 articles were included, nine qualitative studies and 32 quantitative. The quality of the articles varied. Symptoms included commonly reported symptoms and some less prevalent, including some reporting absence of symptoms. Factors that affected symptoms included culture, beliefs, psychosocial factors, and knowledge. We also found that there may be a bidirectional relationship between symptoms and behaviors that may lead to self-management. CONCLUSION HTN is common and symptoms are frequently reported. HTN management is related to multiple factors. Symptoms continue in a number of individuals after initial diagnosis. Evaluating symptoms after initial diagnosis may help to optimally manage and meet blood pressure guidelines.
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Affiliation(s)
- Carolyn E Horne
- School of Nursing, University of North Carolina - Charlotte, Charlotte, North Carolina, USA
| | - Louise C Stayt
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Susan Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | | | | | - Linda P Bolin
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Catherine L Taylor
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | | | - Adam Bibbey
- Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial. Trials 2022; 23:841. [PMID: 36192769 PMCID: PMC9527393 DOI: 10.1186/s13063-022-06764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs' social networks. Fifty to 75% of AWDs have an unpaid family member or friend ("support person") who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs' diabetes management. METHODS This parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach. The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months. The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient's diabetes. We also will assess the effect of the COVID-19 pandemic on patient's ability to manage diabetes. DISCUSSION This study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described. TRIAL REGISTRATION ClinicalTrials.gov NCT03812614. Registered on 18 January 2019.
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Spikes T, Murden R, McKinnon II, Bromfield S, Van Dyke ME, Moore RH, Rahbari-Oskoui FF, Quyummi A, Vaccarino V, Lewis TT. Association of Net Worth and Ambulatory Blood Pressure in Early Middle-aged African American Women. JAMA Netw Open 2022; 5:e220331. [PMID: 35201307 PMCID: PMC8874347 DOI: 10.1001/jamanetworkopen.2022.0331] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Low socioeconomic status (SES) in the form of educational level and income has been linked to greater cardiovascular risk across cohorts; however, associations have been inconsistent for African American individuals. Net worth, a measure of overall assets, may be a more relevant metric, especially for African American women, because it captures longer-term financial stability and economic reserve. OBJECTIVE To examine whether net worth is associated with increased ambulatory blood pressure (ABP), a marker of cardiovascular disease (CVD) risk, independent of educational level and income, in young to middle-aged African American women. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, community-based study conducted in the southeastern US was performed using 48-hour ambulatory BP monitoring. Participants included 384 African American women aged 30 to 46 years without clinical CVD recruited between December 16, 2016, and March 21, 2019; data analysis was performed from September 2020 to December 2021. EXPOSURES Self-reported net worth (total financial assets minus debts), self-reported educational level, and self-reported income. MAIN OUTCOMES AND MEASURES Mean daytime and nighttime BP levels, assessed via 48-hour ABP monitoring and sustained hypertension (ABP daytime and clinic BP ≥130/80 mm Hg). RESULTS The 384 African American women in this study represented a range of SES backgrounds; mean (SD) age was 38.0 (4.3) years. Excluding 66 women who were not receiving antihypertensive medications, in linear regression models adjusted for age, marital status, educational level, family income, and family size, women reporting a negative net worth (debt) had higher levels of daytime (β = 6.7; SE = 1.5; P < .001) and nighttime (β = 6.4; SE = 1.4; P < .001) systolic BP, compared with women reporting a positive net worth. Similar associations were observed with sustained hypertension: women reporting a negative net worth had 150% higher odds (odds ratio, 2.5; 95% CI, 1.3-4.7) of sustained hypertension than those reporting a positive net worth. Associations remained significant after additional adjustments for smoking, body mass index, psychosocial stress due to debt, and depressive symptoms and were similar, although attenuated, when women receiving antihypertensive medications were included and treatment was controlled for in all analyses. CONCLUSIONS AND RELEVANCE In this cross-sectional study, having a negative net worth (ie, debt) was associated with elevated BP in African American women, independent of traditional indicators of SES. This finding suggests that limited assets or a lack of economic reserve may be associated with poor CVD outcomes in this at-risk group.
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Affiliation(s)
- Telisa Spikes
- School of Nursing, Emory University, Atlanta, Georgia
| | - Raphiel Murden
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Izraelle I. McKinnon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Miriam E. Van Dyke
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Renee H. Moore
- Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
| | | | - Arshed Quyummi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Dong M, McGoldrick MT, Seid H, Cohen LP, LaRocca A, Pham P, Thomas SJ, Schwartz JE, Shimbo D. The stress, salt excretion, and nighttime blood pressure (SABRE) study: Rationale and study design. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100099. [PMID: 38560071 PMCID: PMC10978196 DOI: 10.1016/j.ahjo.2022.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 04/04/2024]
Abstract
Background Abnormal diurnal patterns of blood pressure (BP) on ambulatory BP monitoring (ABPM), defined by reduced BP dipping or elevated nighttime BP, are associated with increased risk for adverse cardiovascular events. Psychological stress is associated with abnormal diurnal patterns of BP. Exposure to an acute stressor (e.g., mental stress task) normally increases urinary sodium excretion. However, some individuals have sodium retention after stress provocation, revealing substantial between-person variability in the degree of stress-induced sodium excretion. Prior research suggests urinary sodium excretion that does not occur during the daytime may shift toward the nighttime, accompanied by an increase in nighttime BP. Associations between psychological stress and the diurnal patterns of sodium excretion and BP are not yet fully understood. Design The study is conducted in both the laboratory and naturalistic environment with a multi-racial/ethnic sample of 211 healthy adults. In the laboratory, change in urinary sodium excretion in response to mental stress tasks is examined with pre-/post-stress assessments of sodium excretion. Changes in angiotensin-II, catecholamines, BP, heart rate, endothelin-1, and cortisol are also assessed. In the 24-hour naturalistic environment, the diurnal patterns of sodium excretion and systolic BP are assessed as daytime-to-nighttime ratio of sodium excretion and ABPM, respectively. Ecological momentary assessments of perceived stress are also collected. Summary The SABRE study investigates previously unexplored associations between stress-induced urinary excretion in the laboratory, diurnal patterns of sodium excretion and BP in the naturalistic environment, and ecological stress. It has high potential to advance our understanding of the role of psychological stress in hypertension.
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Affiliation(s)
- Melissa Dong
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America
| | - Matthew T. McGoldrick
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America
| | - Heather Seid
- Bionutrition Research Core, Irving Institute of Clinical and Translational Research, Columbia University, 622 West 168th Street, New York, NY 10032, United States of America
| | - Laura P. Cohen
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America
| | - Ariana LaRocca
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America
| | - Patrick Pham
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America
| | - S. Justin Thomas
- Department of Psychiatry, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294, United States of America
| | - Joseph E. Schwartz
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, United States of America
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America
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Park JW, Dulin AJ, Needham BL, Sims M, Loucks EB, Fava JL, Dionne LA, Scarpaci MM, Eaton CB, Howe CJ. Examining Optimism, Psychosocial Risks, and Cardiovascular Health Using Life's Simple 7 Metrics in the Multi-Ethnic Study of Atherosclerosis and the Jackson Heart Study. Front Cardiovasc Med 2021; 8:788194. [PMID: 34977194 PMCID: PMC8714850 DOI: 10.3389/fcvm.2021.788194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Optimism has been shown to be positively associated with better cardiovascular health (CVH). However, there is a dearth of prospective studies showing the benefits of optimism on CVH, especially in the presence of adversities, i.e., psychosocial risks. This study examines the prospective relationship between optimism and CVH outcomes based on the Life's Simple 7 (LS7) metrics and whether multilevel psychosocial risks modify the aforementioned relationship. Methods: We examined self-reported optimism and CVH using harmonized data from two U.S. cohorts: Multi-Ethnic Study of Atherosclerosis (MESA) and Jackson Heart Study (JHS). Modified Poisson regression models were used to estimate the relationship between optimism and CVH using LS7 among MESA participants (N = 3,520) and to examine the relationship of interest based on four biological LS7 metrics (body mass index, blood pressure, cholesterol, and blood glucose) among JHS and MESA participants (N = 5,541). For all CVH outcomes, we assessed for effect measure modification by psychosocial risk. Results: Among MESA participants, the adjusted risk ratio (aRR) for ideal or intermediate CVH using LS7 comparing participants who reported high or medium optimism to those with the lowest level of optimism was 1.10 [95% Confidence Interval (CI): 1.04-1.16] and 1.05 (95% CI: 0.99-1.11), respectively. Among MESA and JHS participants, the corresponding aRRs for having all ideal or intermediate (vs. no poor) metrics based on the four biological LS7 metrics were 1.05 (0.98-1.12) and 1.04 (0.97-1.11), respectively. The corresponding aRRs for having lower cardiovascular risk (0-1 poor metrics) based on the four biological LS7 metrics were 1.01 (0.98-1.03) and 1.01 (0.98-1.03), respectively. There was some evidence of effect modification by neighborhood deprivation for the LS7 outcome and by chronic stress for the ideal or intermediate (no poor) metrics outcome based on the four biological LS7 metrics. Conclusion: Our findings suggest that greater optimism is positively associated with better CVH based on certain LS7 outcomes among a racially/ethnically diverse study population. This relationship may be effect measure modified by specific psychosocial risks. Optimism shows further promise as a potential area for intervention on CVH. However, additional prospective and intervention studies are needed.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Brown University, Providence, RI, United States
- Department of Epidemiology, Brown University, Providence, RI, United States
| | - Akilah J. Dulin
- Center for Epidemiologic Research, Brown University, Providence, RI, United States
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity Research, Brown University, Providence, RI, United States
| | - Belinda L. Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Eric B. Loucks
- Department of Epidemiology, Brown University, Providence, RI, United States
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity Research, Brown University, Providence, RI, United States
| | - Joseph L. Fava
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity Research, Brown University, Providence, RI, United States
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Laura A. Dionne
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity Research, Brown University, Providence, RI, United States
| | - Matthew M. Scarpaci
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, United States
| | - Charles B. Eaton
- Department of Epidemiology, Brown University, Providence, RI, United States
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Chanelle J. Howe
- Center for Epidemiologic Research, Brown University, Providence, RI, United States
- Department of Epidemiology, Brown University, Providence, RI, United States
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Cui F, Zhang N, Yi J, Liang Y, Liu Q. Influence of Hostility on 24-Hour Diastolic Blood Pressure Load in Hypertension Patients with Depressive Disorders. Med Sci Monit 2021; 27:e929710. [PMID: 33640897 PMCID: PMC7931454 DOI: 10.12659/msm.929710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hostility in hypertension patients combined with depressive disorders indicates a worse outcome for hypertension management. This study was designed to explore the influence of hostility on 24-h diastolic blood pressure in hypertension patients who also had depressive disorders. MATERIAL AND METHODS A total of 130 people with primary hypertension and depressive disorders were collected through unstructured psychiatric interview by a professional psychiatrist and ambulatory blood pressure monitor in this cross-sectional study. During the study, dynamic blood pressure was examined for 24 h by ambulatory blood pressure monitoring. Patients were divided into 3 groups according to the hostility level. Hostility was defined by hostile factors of the Symptom Checklist 90. The association between hostility and 24-h dynamic blood pressure was analyzed by multivariable logistic regression. RESULTS 30.8% (40 of 130) patients had a high level of 24-h dynamic blood pressure load (>30%), in which 14.6% was for male and 16.2% for female respectively. In male, the proportion of high 24 h DBP load (>30%) in highest hostility group was greater than that of low hostility group and median hostility group significantly (p=0.03). No significant differences were revealed among 3 groups in female. The age-adjusted odds-ratio (OR) 95% confidence interval of diastolic blood pressure across the categories of hostility were: in males, 1.44 (0.60, 3.47) (1 for reference), and in females, 5.86 (0.58, 59.06) (P for trend=0.04). CONCLUSIONS Our results showed that hostility may be a risk factor for increased 24-h diastolic blood pressure in hypertension patients who also have depressive disorders, especially in males. The clinical meaning of the study is that hypertension management should contain psychological interventions for better effects.
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Affiliation(s)
- Feihuan Cui
- Department of Psychology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Na Zhang
- Department of Psychology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jin Yi
- Department of Psychology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yulan Liang
- Department of Psychology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Qi Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China (mainland)
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Denominational and Gender Differences in Hypertension Among African American Christian Young Adults. J Racial Ethn Health Disparities 2020; 8:1332-1343. [PMID: 33067763 DOI: 10.1007/s40615-020-00895-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
Hypertension, a major cardiovascular disease risk factor, is disproportionately prevalent among African American young adults. Religion and spirituality (R/S) have been studied for their potential effect on blood pressure (BP) outcomes. Despite their disproportionate hypertension risk and high levels of R/S engagement, limited research explores BP differences among religious African Americans. This study investigates whether denominational affiliation predicts within-group differences in odds of having hypertension among African American Christian young adults. Data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were used to examine hypertension differences between 1932 African American young adults based on self-reported religious denomination. Gender-separated logistic regressions included religious service attendance and coping measures, as well as personal characteristics and health behaviors to adjust for potential effects on BP. The odds of having hypertension were higher for Pentecostal women compared to Baptist and Catholic women. Hypertension odds for women who reported attending services more than once weekly were lower than those who never attended church. For women, frequent use of religious coping predicted higher odds of having hypertension than seldom or never using religious coping. R/S variables did not predict significant differences among men. The health benefits of R/S do not appear to be consistent within African American Christian young adults. Religion may be viewed as a source of BP risk and resilience, especially among African American young women.
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Sims M, Glover LSM, Gebreab SY, Spruill TM. Cumulative psychosocial factors are associated with cardiovascular disease risk factors and management among African Americans in the Jackson Heart Study. BMC Public Health 2020; 20:566. [PMID: 32345300 PMCID: PMC7189712 DOI: 10.1186/s12889-020-08573-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. METHODS Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. RESULTS After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16-1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01-1.52 and PR 1.13 95% CI 1.03-1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03-1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46-0.84). CONCLUSIONS Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, 350 W. Woodrow Wilson Avenue, Jackson, MS 39213, USA
| | - Lá Shauntá M. Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Tanya M. Spruill
- Department of Population Health, NYU School of Medicine, New York, USA
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Sakhuja S, Booth JN, Lloyd-Jones DM, Lewis CE, Thomas SJ, Schwartz JE, Shimbo D, Shikany JM, Sims M, Yano Y, Muntner P. Health Behaviors, Nocturnal Hypertension, and Non-dipping Blood Pressure: The Coronary Artery Risk Development in Young Adults and Jackson Heart Study. Am J Hypertens 2019; 32:759-768. [PMID: 30715142 PMCID: PMC6636688 DOI: 10.1093/ajh/hpz017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/20/2018] [Accepted: 01/28/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several health behaviors have been associated with hypertension based on clinic blood pressure (BP). Data on the association of health behaviors with nocturnal hypertension and non-dipping systolic BP (SBP) are limited. METHODS We analyzed data for participants with ambulatory BP monitoring at the Year 30 Coronary Artery Risk Development in Young Adults (CARDIA) study exam in 2015-2016 (n = 781) and the baseline Jackson Heart Study (JHS) exam in 2000-2004 (n = 1,046). Health behaviors (i.e., body mass index, physical activity, smoking, and alcohol intake) were categorized as good, fair, and poor and assigned scores of 2, 1, and 0, respectively. A composite health behavior score was calculated as their sum and categorized as very good (score range = 6-8), good (5), fair (4), and poor (0-3). Nocturnal hypertension was defined as mean asleep SBP ≥ 120 mm Hg or mean asleep diastolic BP ≥ 70 mm Hg and non-dipping SBP as < 10% awake-to-asleep decline in SBP. RESULTS Among CARDIA study and JHS participants, 41.1% and 56.9% had nocturnal hypertension, respectively, and 32.4% and 72.8% had non-dipping SBP, respectively. The multivariable-adjusted prevalence ratios (95% confidence interval) for nocturnal hypertension associated with good, fair, and poor vs. very good health behavior scores were 1.03 (0.82-1.29), 0.98 (0.79-1.22), and 0.96 (0.77-1.20), respectively in CARDIA study and 0.98 (0.87-1.10), 0.96 (0.86-1.09), and 0.86 (0.74-1.00), respectively in JHS. The health behavior score was not associated non-dipping SBP in CARDIA study or JHS after multivariable adjustment. CONCLUSIONS A health behavior score was not associated with nocturnal hypertension or non-dipping SBP.
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Affiliation(s)
- Swati Sakhuja
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John N Booth
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Joseph E Schwartz
- Columbia University, New York, USA
- Stony Brook University, Stony Brook, New York, USA
| | | | - James M Shikany
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mario Sims
- University of Mississippi, Jackson, Mississippi, USA
| | | | - Paul Muntner
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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14
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Social aggravation: Understanding the complex role of social relationships on stress and health-relevant physiology. Int J Psychophysiol 2018; 131:13-23. [DOI: 10.1016/j.ijpsycho.2018.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022]
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15
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Booth III JN, Li M, Shimbo D, Hess R, Irvin MR, Kittles R, Wilson JG, Jorde LB, Cheung AK, Lange LA, Lange EM, Yano Y, Muntner P, Bress AP. West African Ancestry and Nocturnal Blood Pressure in African Americans: The Jackson Heart Study. Am J Hypertens 2018. [PMID: 29528363 DOI: 10.1093/ajh/hpy038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND African Americans have a higher prevalence of nocturnal hypertension and nondipping blood pressure than European Americans, but the genetic contribution to these racial differences remains unclear. We assessed the association of the percentage West African genetic ancestry with nocturnal hypertension and nondipping blood pressure in 932 African Americans from the Jackson Heart Study. METHODS Using percentage West African ancestry determined from 389 ancestry informative markers, participants were categorized into tertiles (tertile 1 [low]: <79.3%, tertile 2: ≥79.3-86.3%, and tertile 3 [high]: >86.3%). Nocturnal hypertension was defined as mean nighttime (midnight-6 am) systolic (SBP)/diastolic blood pressure ≥120/70 mm Hg. Nondipping blood pressure was defined as mean nighttime-to-daytime (10 am-8 pm) SBP ratio >0.90. RESULTS Nocturnal hypertension was present in 57.9% of participants; 66.6% had nondipping blood pressure. The mean age was 59.4 years, 32.8% were male, and 56.0% were taking antihypertensive medication. The prevalence ratios (95% confidence interval) adjusted for age, sex, cardiovascular disease risk factors, and socioeconomic and psychosocial factors comparing participants with moderate and high to those with low percentage West African ancestry for nocturnal hypertension were 0.98 (0.87-1.10) and 0.95 (0.84-1.08), respectively, and for nondipping blood pressure was 0.96 (0.86-1.07) and 0.98 (0.88-1.09), respectively. CONCLUSIONS West African ancestry was not associated with nocturnal hypertension and nondipping blood pressure among African Americans. While rare genetic variants cannot be ruled out, these data highlight the need to better understand how environmental and behavioral factors contribute to differences in nocturnal blood pressure among African Americans compared with European Americans.
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Affiliation(s)
- John N Booth III
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Man Li
- Divsion of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, New York, USA
| | - Rachel Hess
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rick Kittles
- Division of Health Equities, Department of Population Sciences, City of Hope, Pasadena, California, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lynn B Jorde
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alfred K Cheung
- Divsion of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Leslie A Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ethan M Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yuichiro Yano
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam P Bress
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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16
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Irvin MR, Booth JN, Sims M, Bress AP, Abdalla M, Shimbo D, Calhoun DA, Muntner P. The association of nocturnal hypertension and nondipping blood pressure with treatment-resistant hypertension: The Jackson Heart Study. J Clin Hypertens (Greenwich) 2018; 20:438-446. [PMID: 29436105 DOI: 10.1111/jch.13199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 12/31/2022]
Abstract
Apparent treatment-resistant hypertension (aTRH), nocturnal hypertension, and nondipping blood pressure (BP) have shared risk factors. The authors studied the association between aTRH and nocturnal hypertension and aTRH and nondipping BP among 524 black Jackson Heart Study participants treated for hypertension. Nocturnal hypertension was defined by mean nighttime systolic BP ≥120 mm Hg or diastolic BP ≥70 mm Hg. Nondipping BP was defined by mean nighttime to daytime systolic BP ratio >0.90. aTRH was defined by mean clinic systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg with three medication classes or treatment with four or more classes. The risk for developing aTRH associated with nondipping BP and nocturnal hypertension was estimated. After multivariable adjustment, participants with aTRH were more likely to have nocturnal hypertension (prevalence ratio, 1.20; 95% confidence interval, 1.03-1.39) and nondipping (prevalence ratio, 1.25; 95% confidence interval, 1.09-1.43). Over a median 7.3 years of follow-up, nocturnal hypertension and nondipping BP at baseline were not associated with developing aTRH after adjustment.
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Affiliation(s)
- Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John N Booth
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marwah Abdalla
- Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - David A Calhoun
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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17
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Zullig LL, Diamantidis CJ, Bosworth HB, Bhapkar MV, Barnhart H, Oakes MM, Pendergast JF, Miller JJ, Patel UD. Racial differences in nocturnal dipping status in diabetic kidney disease: Results from the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study. J Clin Hypertens (Greenwich) 2017; 19:1327-1335. [PMID: 28834119 PMCID: PMC5722697 DOI: 10.1111/jch.13088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/30/2017] [Accepted: 06/04/2017] [Indexed: 11/29/2022]
Abstract
While racial variation in ambulatory blood pressure (BP) is known, patterns of diurnal dipping in the context of diabetic kidney disease have not been well defined. The authors sought to determine the association of race with nocturnal dipping status among participants with diabetic kidney disease enrolled in the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) trial. The primary outcome was nocturnal dipping-percent decrease in average systolic BP from wake to sleep-with categories defined as reverse dippers (decrease <0%), nondippers (0%-<10%), and dippers (≥10%). Twenty-four-hour ambulatory BP monitoring was completed by 108 participants (54% were nondippers, 24% were dippers, and 22% were reverse dippers). In adjusted models, the common odds of reverse dippers vs nondippers/dippers and reverse dippers/nondippers vs dippers was 2.6 (95% confidence interval, 1.2-5.8) times higher in blacks than in whites. Without ambulatory BP monitoring data, interventions that target BP in black patients may be unable to improve outcomes in this high-risk group.
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Affiliation(s)
- Leah L. Zullig
- Center of Excellence for Health Services Research in Primary CareDurham Veterans Affairs Health Care CenterDurhamNCUSA
- Division of General Internal MedicineDuke UniversityDurhamNCUSA
| | | | - Hayden B. Bosworth
- Center of Excellence for Health Services Research in Primary CareDurham Veterans Affairs Health Care CenterDurhamNCUSA
- Division of General Internal MedicineDuke UniversityDurhamNCUSA
- Department of Psychiatry and School of NursingDuke UniversityDurhamNCUSA
| | | | - Huiman Barnhart
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNCUSA
| | - Megan M. Oakes
- Division of General Internal MedicineDuke UniversityDurhamNCUSA
| | - Jane F. Pendergast
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNCUSA
| | - Julie J. Miller
- Division of General Internal MedicineDuke UniversityDurhamNCUSA
| | - Uptal D. Patel
- Division of NephrologyDuke UniversityDurhamNCUSA
- Gilead SciencesSan FranciscoCAUSA
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18
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Psychosocial correlates of apparent treatment-resistant hypertension in the Jackson Heart Study. J Hum Hypertens 2017; 31:486. [PMID: 28588315 DOI: 10.1038/jhh.2017.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This corrects the article DOI: 10.1038/jhh.2016.100.
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19
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Shallcross AJ, Butler M, Tanner RM, Bress AP, Muntner P, Shimbo D, Ogedegbe G, Sims M, Spruill TM. Psychosocial correlates of apparent treatment-resistant hypertension in the Jackson Heart Study. J Hum Hypertens 2017; 31:474-478. [PMID: 28124682 DOI: 10.1038/jhh.2016.100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/25/2016] [Accepted: 12/19/2016] [Indexed: 01/01/2023]
Abstract
Apparent treatment-resistant hypertension (aTRH) is associated with adverse cardiovascular outcomes. aTRH is common and disproportionately affects African Americans. The objective of this study is to explore psychosocial correlates of aTRH in a population-based cohort of African Americans with hypertension. The sample included 1392 participants in the Jackson Heart Study with treated hypertension who reported being adherent to their antihypertensive medications. aTRH was defined as uncontrolled clinic BP (⩾140/90 mm Hg) with ⩾3 classes of antihypertensive medication or treatment with ⩾4 classes of antihypertensive medication, including a diuretic. Self-reported medication adherence was defined as taking all prescribed antihypertensive medication in the 24 h before the study visit. The association of psychosocial factors (chronic stress, depressive symptoms, perceived social support and social network) with aTRH was evaluated using Poisson regression with progressive adjustment for demographic, clinical and behavioural factors. The prevalence of aTRH was 15.1% (n=210). Participants with aTRH had lower social network scores (that is, fewer sources of regular social contact) compared with participants without aTRH (P<0.01). No other psychosocial factors differed between groups. Social network was also the only psychosocial factor that was associated with aTRH prevalence in regression analyses. In age-, sex-adjusted and fully adjusted models, one additional unique source of social contact was associated with a 19% (PR=0.81; 95% confidence interval (CI): 0.68-0.94, P=0.001) and a 13% (PR=0.87; 95% CI 0.74-1.0, P=0.041) lower prevalence of aTRH, respectively. Social network was independently associated with aTRH and warrants further investigation as a potentially modifiable determinant of aTRH in African Americans.
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Affiliation(s)
- A J Shallcross
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - M Butler
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - R M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A P Bress
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - P Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - G Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - M Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - T M Spruill
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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20
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Sims M, Lipford KJ, Patel N, Ford CD, Min YI, Wyatt SB. Psychosocial Factors and Behaviors in African Americans: The Jackson Heart Study. Am J Prev Med 2017; 52:S48-S55. [PMID: 27989292 DOI: 10.1016/j.amepre.2016.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There are limited reports on the association of psychosocial factors with unhealthy behaviors, which are key mediators in the psychosocial-cardiovascular disease pathway. The Jackson Heart Study was used to examine the associations of multiple psychosocial factors with behaviors among African Americans. METHODS The Jackson Heart Study is a prospective, cohort study of cardiovascular disease among African Americans recruited from the Jackson, MS, metropolitan area between 2000 and 2004. Between 2015 and 2016, multivariable regression was used to analyze the cross-sectional associations of baseline negative affect (cynicism, anger-in, anger-out, and depressive symptoms) and stressors (global stress, Weekly Stress Inventory-event, Weekly Stress Inventory-impact, and major life events) with the odds of current smoking and mean differences in dietary fat intake, physical activity, and hours of sleep. RESULTS Men were more likely to smoke than women (p<0.001) and had higher physical activity scores (p<0.001). Women reported more hours of sleep (p=0.001). In fully adjusted models, each negative affect and stress measure was significantly associated with an increased odds of current smoking. For example, the odds of smoking increased by 14% for each 1-SD increase in cynical distrust score (OR=1.14, 95% CI=1.01, 1.27) in the fully adjusted model. Further, each negative affect and stress measure (except anger-out) was significantly associated with fewer hours of sleep in fully adjusted models. CONCLUSIONS Using a large sample of African Americans, this study found that multiple psychosocial risk factors were associated with unhealthy behaviors that are prevalent among this population.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Kristie J Lipford
- School of Social Work, Jackson State University, Jackson, Mississippi
| | - Nikhil Patel
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Cassandra D Ford
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sharon B Wyatt
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi
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