High Levels of Chronic Stress, High Blood Pressure Linked in African Americans

African Americans who report high levels of chronic stress were shown to be at a heightened risk of developing high blood pressure, or hypertension, with specific stressors such as discrimination and socioeconomic status serving as possible catalysts, according to a study published today in the Journal of the American Heart Association (AHA).¹

African Americans and Hispanics are disproportionately affected by inflammatory-related conditions such as asthma and diabetes, which are aggravated by chronic stress, environmental pollution, and exposure to trauma. In a study on chronic stress exposure among young black children with asthma, mortality rates showed black children to be 8 times more likely than white children to die of asthma, based on CDC data.²

As the authors from the AHA study note, African Americans experience greater exposure to specific chronic stress factors such as discrimination and low socioeconomic status, which may precipitate a higher risk. In the past week, Atatiana Jefferson, an African American woman, was killed in her home by a white officer who fired 1 bullet through her bedroom window when responding to a call from a concerned neighbor. This case, as well as that of the police officer who walked into the wrong apartment and killed an unarmed black man, may contribute to the persistent psychosocial stress prominent in African American communities.

As psychosocial stress is involved in the development of hypertension, lead study author Tanya Spruill, PhD, associate professor in the Department of Population Health and Medicine at NYU School of Medicine, emphasized that accounting for these potentially higher risks found in African Americans can assist in improving treatment.

“Given the disproportionately high burden of hypertension in African Americans, determining if chronic stress increases the risk of hypertension in this population is an important question that could guide prevention strategies,” said Spruill.

To examine the association of perceived stress levels and incident hypertension in African Americans, researchers derived data from the Jackson Heart Study, a community-based black cohort study, on in-home interviews and clinic exams in which blood pressure was measured across 3 exam periods. Analyses included 1829 participants without hypertension at baseline (exam 1, 2000-2004), with stress levels assessed annually for up to 13 years:

• Incident hypertension defined as blood pressure of at least 140/90 mm Hg or antihypertensive medication use at exam 2 (2005-2008) or exam 3 (2009-2012)
• Follow-up intervals at risk of hypertension categorized as low, moderate, or high perceived stress (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings)

Study results exhibited a stark association between hypertension incidence and increased stress as age, sex, and time-adjusted risk ratios (RRs) presented those with high perceived stress as having a 37% greater risk than low perceived stress subjects (RR, 1.37; 95% CI, 1.20-1.57; P <.001) and a heightened risk of 19% in moderate stress participants compared with those with low stress (RR, 1.19; 95% CI, 1.04-1.37; P <.001). Overall, hypertension incidence was 48.5% in the study cohort, with 30.6% attributed to intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress.

Researchers found that after approximately 7 years, African Americans who reported high stress levels were found to have a 22% increased risk of developing high blood pressure when compared with low stress participants (RR, 1.22; 95% CI, 1.07-1.39; P = .001). This prevalence of high blood pressure development among participants with high stress levels suggest that chronic stress may contribute negatively to cardiovascular health over time, with a chief impact on hypertension incidence.

As Spruill noted, nearly half of the participants developed hypertension.

“This highlights the need for new hypertension prevention strategies for African Americans. Lifestyle change is effective, however, it can be challenging to achieve,” said Spruill.

The socioeconomic dynamic behind chronic stress in minorities remains an issue that additionally subjects African American and Hispanic children to heightened risks for inflammatory conditions.³ As African American children were shown to respond differently to asthma medications, alternative treatment approaches are needed to effectively reduce complications from increased risks.

Spruill emphasized that further investigation into preventive measures is warranted, with a culturally sensitive stress management intervention recommended as a possible benefit for African Americans.

“We believe intervention studies are needed to determine if reducing stress among African Americans can reduce the risk of developing hypertension. This could have a significant impact on cardiovascular health outcomes and disparities,” said Spruill.

References

1. Spruill TM, Butler MJ, Thomas SJ, et al. Association between high perceived stress over time and incident hypertension in black adults: findings from the Jackson Heart Study. J Am Heart Assoc. 2019;8(21):e012139. doi: 10.1161/JAHA.119.012139.

2. Jones BL, Staggs V, Woods-Jaeger B. Chronic stress among young African American children with asthma: racism is a factor [published online September 3, 2019]. Ann Allergy Asthma Immunol. doi: 10.1016/j.anai.2019.08.023.

3. Schmeer KK, Tarrence J. Racial/ethnic disparities in inflammation: evidence of weathering in childhood? J Health Soc Behav. 2018;59(3):411-428. doi: 10.1177/0022146518784592.