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Chronic stress linked to hypertension risk in black US adults

Evaluating stress levels over time and intervening when high perceived stress persists might reduce hypertension risk

Louise Prime

Wednesday, 16 October 2019

Black adults in the US who reported high levels of chronic stress had an increased risk of developing hypertension compared with those who reported low stress levels, community-based research has shown. The authors of the study* said today in the Journal of the American Heart Association that evaluating stress levels over time and intervening when high perceived stress is persistent might reduce hypertension risk.

The researchers pointed out that although chronic psychological stress has been associated with hypertension, few studies have examined this relationship in black adults. They conducted a study to test the association between perceived stress levels, assessed annually for up to 13 years, and incident hypertension in the Jackson Heart Study, a community-based cohort of African Americans.

They analysed data on 1,829 black women and men without hypertension at baseline (2000-04), who at each annual follow-up assessment had had their blood pressure recorded and also self-reported their stress levels over the past year. They coded stress ratings of ‘none’, ‘very little’, ‘mild’ and ‘moderate’ as low perceived stress, and ratings of ‘a lot’ or ‘extreme’ as high perceived stress.

They then categorised each follow-up interval at risk of hypertension as either low, moderate, or high perceived stress, based on the number of annual assessments between exams in which participants had reported ‘a lot’ or ‘extreme’ stress over the prior year (low, no high stress ratings; moderate, one high stress rating; high, at least two high stress ratings).

The study authors reported that over about seven years’ follow up, 887 (48.5%) participants developed incident hypertension – defined as systolic blood pressure (SBP) ≥140mmHg and/or diastolic blood pressure (DBP) ≥90mmHg and/or self-reported use of antihypertensive medication – and that higher perceived stress over time was associated with a greater risk of incident hypertension.

Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress – those who reported high chronic stress levels had a 22% increased risk of developing high blood pressure, compared with people who reported sustained low stress levels. Age, sex and time-adjusted risk ratios associated with moderate and high perceived stress, versus low perceived stress, were 1.19 and 1.37, respectively. The association was present after adjustment for demographic, clinical and behavioural factors, and baseline stress. This, said the study authors, suggests that chronic stress might, over time, have a negative impact on cardiovascular health, particularly hypertension.

They concluded: “The results of [our] study suggest that it is important to evaluate chronic stress over time rather than at a single occasion and to intervene when it is persistent. Identifying effective, culturally sensitive stress management interventions may support primary prevention of hypertension and subsequent CVD [cardiovascular disease] risk among African Americans.”


*Spruill TM, Butler MJ, Thomas SJ, et al. Association between high perceived stress over time and incident hypertension in African Americans: Findings from the Jackson Heart Study. Journal of the American Heart Association 2019; 8: e012139. Published online 16 October 2019.

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