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 Among more than 1,800 participants in a large, long-term health
study in Jackson, Mississippi, researchers found that nearly half
developed high blood pressure, or hypertension, over an average
seven-year follow-up. About 30% of new diagnoses happened after a
period of low stress, about 35% after years of moderate stress and
almost 40% after a period of chronic high stress.
"African Americans who reported high levels of perceived stress over
time were more likely to develop hypertension compared to those who
consistently reported low stress," said Tanya Spruill of the
departments of population health and medicine at the NYU School of
Medicine in New York City, who led the study.
And this was independent of traditional risk factors, including age,
obesity and smoking, Spruill said in an email.
The African American community already faces a high burden of
hypertension, and also of chronic stressors like discrimination and
low socioeconomic status, Spruill's team notes in the Journal of the
American Heart Association.
When the 1,829 participants in the current analysis attended the
first of three assessments, all had normal blood pressure. At that
first visit, between 2000 and 2004, participants had physical exams
and answered interview questions about their lives.
Follow-up phone interviews happened every year, and return visits
for exams and in-person interviews took place in 2005-2008 and in
2009-2012. Between 2005 and 2012, 48.5% of participants were newly
diagnosed with high blood pressure.
After accounting for other hypertension risk factors like obesity or
smoking, Spruill's team calculated that prolonged moderate stress
between exam visits raised the risk of a new high blood pressure
diagnosis at the next exam by 15% compared to low or no stress.
Chronic high stress raised that risk by 22%.
"Few prior studies have included significant numbers of African
Americans," said Spruill, adding the large community-based sample
and yearly reviews of stress were important because stress levels
fluctuate.
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The onset of hypertension was somewhat stronger in women, but the
difference was small and might have been due to chance, the
researchers note.
"Still, there is evidence that women experience different types of
stressors than men and respond differently," Spruill said.
This could be because women have pivotal roles as caregivers and
heads of households in African-American society, said Dr. George E.
Matthews, the SUNY assistant professor of medicine at Jacobs School
of Medicine and Biomedical Sciences at the University at Buffalo in
New York.
"Further research is needed to identify which psychosocial stressor
may be contributing to the risk among women," Matthews, who was not
involved in the study, told Reuters Health by email.
The study did not examine why people felt stressed.
"It could be the environment, diet, exposure to issues in their life
experience," noted Dr. Clyde Yancy, national spokesperson for the
American Heart Association and chief of cardiology at Northwestern
University in Chicago. It could also be "something they were exposed
to, like violence and trauma," he noted in a phone interview.
The study was not designed to determine how stress might raise
hypertension risk and cannot say whether reducing stress would lower
that risk, Spruill said.
Even so, the results highlight the need for culturally-sensitive
stress management interventions for African Americans, the study
authors write.
With hypertension becoming a worldwide burden, this data may apply
wherever stress is a component of life and work experiences, Yancy
said.
SOURCE: https://bit.ly/2PBSuNi Journal of the American Heart
Association, online October 16, 2019.
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