Race/ethnicity, chronic stressors, and hypertension

Background: The reasons for racial/ethnic disparities in hypertension (HTN) are unknown. Methods: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated if individual and neighborhood-level chronic stressors contribute to these disparities. The sample consisted of 2963 MESA participants (45-85yrs) residing in Baltimore, New York, and North Carolina. HTN was defined as systolic or diastolic blood pressure >140 or 90mmHg respectively, or taking anti-hypertensive medications. Individual chronic stress was measured by the amount of chronic burden, perceived discrimination, everyday hassles, and job strain experienced by an individual. A measure of neighborhood (census tract) chronic stressors encompassing domains of physical disorder and violence was developed using data from a phone survey conducted of other residents of MESA neighborhoods. Binomial regression methods were used to estimate associations between HTN and race/ethnicity before and after adjustment for individual and neighborhood stressors. Results: The prevalence of HTN was 59.3% in African Americans (AA), 43.6% in Hispanics, and 41.8% in whites. HTN was not associated with individual chronic stressors, but was associated with neighborhood stressors after adjusting for age, gender, race/ethnicity, education, and income. Age and sex adjusted relative prevalences of HTN (compared to whites) were 1.33 [95% Confidence Interval (CI): 1.25-1.43] for AA and 1.20 [95% CI: 1.06-1.35] for Hispanics. Adjustment for neighborhood chronic stressors reduced these to 1.19 [95% CI: 1.14-1.25] and 1.11 [95% CI: 1.02-1.23] respectively. Additional adjustment for individual-level chronic stressors, income or education did not modify these results. Conclusion: Neighborhood chronic stressors may contribute to race/ethnic differences in hypertensions.