Introduction:
Stressful life events (SLE) have been associated with poor cardiovascular health but most studies have focused on stressors that directly impact the individuals under study, or personal stressors. Research suggests that women, particularly African-American women, may actually be more vulnerable to network stressors (e.g. SLE that impact important others, such as children, spouses and friends). However, few studies have examined this phenomenon.
Hypothesis:
We tested the hypothesis that greater exposure to network, versus personal stressors, would be associated with elevated clinic blood pressure (BP) as well as BP in daily life, assessed via 48-hour ambulatory monitoring.
Methods:
Participants were 395 African-American women aged 30-45 (Mean= 39.5 ±4.6 yrs) from a range of educational backgrounds recruited from a large southeastern metropolitan area. SLE were assessed using a 22-item Stressful Life Events checklist and further classified into personal (e.g. “major accident/assault/robbery happened to you”) or network (e.g. “serious physical illness, injury or drug/alcohol problem in someone family member/friend”) stressors and summed. Clinic and 48-hr ambulatory BP measurements were assessed and sustained hypertension (HTN) was defined as both clinic (≥130/80mmHg) and ambulatory HTN (≥130/80mmHg), using 2017 AHA/ACC guidelines. Logistic regression analyses were used to examine the associations between types of stressors and sustained HTN after adjusting for age, education, body mass index, and BP meds.
Results:
Approximately 51.2% (N=211) of women had clinic HTN and 29.9% (N=123) of women had sustained HTN (elevated in both clinic and in daily life). In unadjusted multivariable logistic regression analyses, each additional network stressor was associated with a greater likelihood of having elevated clinic (OR-1.21 [1.04-1.40]) and sustained HTN (OR- OR-1.22 [1.04-1.43]). Findings for clinic (OR-1.25, [1.06-1.48]) and sustained HTN (OR-1.23, [1.04-1.46]) remained significant after adjustment for covariates. There were no significant associations between reports of personal stressors and either clinic, or sustained HTN in unadjusted or adjusted analyses.
Discussion:
Network, but not personal stressors, were associated with elevated rates of HTN, both in clinic and daily life for African-American women. Future research is needed to determine whether interventions targeting stress management for network stressors specifically might impact BP in this high-risk population.