Does psychosocial stress cause hypertension? A systematic review of observational studies

Higher adherence to a Mediterranean-type diet is associated with reduced psychosocial stress levels in baby boomers: a cross-sectional study

BACKGROUND/OBJECTIVES

This study investigated the relationship between adherence to the Mediterranean diet among Korean baby boomers and their levels of psychosocial stress.

SUBJECTS/METHODS

The study included 1,656 adults (889 men and 797 women) born between 1955 and 1963 who participated in the 2005-2006 survey of the community-based Korean Genome and Epidemiology Study (KoGES). The Mediterranean-type diet score (MTDS) was calculated from the semi-quantitative food frequency questionnaire (SQFFQ) data. The psychosocial stress levels were calculated using the psychosocial well-being index-short form (PWI-SF). Logistic regression analyses were performed to analyze the association between the MTDS (tertiles) and the prevalence of high psychosocial stress by gender.

RESULTS

The ranges of the MTDS tertile groups were T1 (20-33 points), T2 (34-37 points), and T3 (38-39 points) for men, T1 (20-33 points), T2 (34-37 points), and T3 (38-48 points) for women. In both men and women, the consumption of whole grains, potatoes, fruits, vegetables, legumes, and fish increased with higher MTDS, while the consumption of red meat and dairy products decreased (P for trend < 0.05). As MTDS score increased the intake of energy, fiber, vitamins, and minerals (P for trend < 0.05). Men in the highest MTDS tertile had a 41% lower odds ratio (OR) of high psychosocial stress compared with those in the lowest tertile (OR, 0.59; 95% confidence interval [CI], 0.38-0.91). Similarly, women in the highest tertile of the MTDS had a 39% lower OR of high psychosocial stress compared with those in the lowest tertile (OR, 0.61; 95% CI, 0.40-0.95).

CONCLUSION

Promoting adherence to the Mediterranean diet among baby boomers may have a positive impact on reducing their levels of psychosocial stress.

Effect of mindfulness-based interventions on people with prehypertension or hypertension: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Hypertension and prehypertension have been widely recognized as the main contributors of global mortality. Evidence shows mindfulness-based interventions may reduce blood pressure and improve mental health. However, the effect of mindfulness-based interventions on blood pressure and mental health has not been fully understood.

METHODS

Potential studies published before May 24th 2023 were identified by searching Embase, Ovid Emcare, PsycINFO, CINAHL, Web of Science, Cochrane, PubMed, China National Knowledge Infrastructure, Wanfang database, and VIP China Science. Additionally, two grey databases were searched: Mednar, WorldWideScience.org. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias Assessment tool. The random-effects meta-analyses were conducted using Review Man 5.4 software and the key outcomes are presented as mean difference or standard mean difference and the 95% confidential interval.

RESULTS

Searches returned 802 studies in total, of which 12 were included (N = 715). The duration of interventions was 8 weeks in 10 trials and 6 weeks in one trial. Pooled effect sizes indicated reductions in systolic blood pressure (MD = - 9.12, 95% CI [- 12.18, - 6.05], p < 0.001), diastolic blood pressure (MD = - 5.66, 95% CI [- 8.88, - 2.43], p < 0.001), anxiety (SMD = - 4.10; 95% CI [- 6.49, - 1.71], p < 0.001), depression (SMD = - 1.70, 95%CI [- 2.95, - 0.44], p < 0.001) and perceived stress (SMD = - 5.91, 95%CI [- 8.74, - 3.09], p < 0.001) at post-intervention. The findings from subgroup analyses are favorable for mindfulness-based interventions regardless of gender and baseline blood pressure with regard to BP reduction, with a more profound effect observed in participants with higher pre-intervention blood pressure.

CONCLUSIONS

The results provide evidence for the positive role of mindfulness-based interventions in hypertension management. More large randomized control trials with sufficient statistical power and long-term follow-up are needed.

TRIAL REGISTRATION

The protocol had been registered with Prospero on October 2nd 2021 (registration NO. CRD42021282504 ).

Hypertension with hidden causes: the cognitive and behavioral profile of an adult female with chronic stress and 16p11.2 microdeletion

This case report aims to alert physicians to neuropsychological features and chromosomal variants that may underly resistant hypertension. We present a 35-year-old female patient with hypertensive crisis (BP 260/160 mmHg), initially treated with a combination of calcium antagonists, beta blockers, diuretics and angiotensin-converting enzyme (ACE)-inhibitors, though with little improvement. Cushing's syndrome, Conn's syndrome, and glucocorticoid receptor deficiency were ruled out. Multidisciplinary examination of medical history and (hetero)anamneses including psychosocial factors revealed mild dysmorphic body features, developmental delay, early diagnosis of autism spectrum disorder, a history of being bullied at school, little peer contact, learning disabilities, and special education. Neuropsychological assessment demonstrated below average to low average intelligence quotient, cognitive impairments, and psychopathology. Parallel genetic analyses revealed a rare 16p11.2 microdeletion syndrome. These concurrent examinations explained the patient's life-long high stress levels. After psychological treatment, with additional support at home, her blood pressure lowered to normal levels and antihypertensive drugs were no longer needed.

Job stress, a source of hypertension among workers in Sub-Saharan Africa: a scoping review

BACKGROUND

Hypertension remains one of the leading risk factors for cardiovascular disease. Contrasting with the high-income countries where the rates of hypertension decline, it increases in Sub-Saharan African countries. The age group most affected by hypertension is the working population. Several studies carried out in Europe, North America, and Asia, underline the influence of job stress on the occurrence of hypertension. The objective of this review was to explore current knowledge about hypertension and job stress in Sub-Saharan Africa.

METHODS

We conducted a scoping review using Arksey and O'Malley's framework to synthesize findings. We searched in PubMed, Scopus, and ProQuest databases. The inclusion criteria were peer-reviewed manuscripts published on March 1, 2023, conducted among workers in Sub-Saharan Africa, reported hypertension and job stress, and using quantitative methodologies. Data were assessed independently by two researchers.

RESULTS

In total, 295 articles were identified from databases. Of these, only 12 articles met the inclusion criteria and were included in the review (9 cross-sectional studies and 3 case-control studies). These studies focused on sectors reported as stressful (health, banking, education, and industries). The prevalence of hypertension varied from 14.3% to 45.9%, with a high proportion of hypertensive participants (35.4%-70.6%) who were unaware that they had hypertension. Job stress was significantly associated with hypertension (OR = 2.4 [1.5-4.4]) and stress management was inversely associated with hypertension (r = -0.14, p < 0.05). However, no study reported an existing workplace health promotion program implemented, especially regarding cardiovascular disease risk factors.

CONCLUSION

Data available in the literature show that stressful working conditions may be associated with hypertension. We are faced with an increasing prevalence of hypertension among workers in Sub-Saharan Africa, where a large proportion of them are unaware that they have hypertension. Thus, there is a need to implement workplace prevention and health promotion strategies in Sub-Saharan Africa.

Association of Unfavorable Social Determinants of Health With Stroke/Transient Ischemic Attack and Vascular Risk Factors in Hispanic/Latino Adults: Results From Hispanic Community Health Study/Study of Latinos

BACKGROUND AND PURPOSE

Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US.

METHODS

We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses.

RESULTS

For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P<0.0001). In bivariate analysis, income <$20,000, education less than high school, no health insurance, perceived discrimination, not currently employed, upper tertile for chronic stress, and lower tertiles for social support and language- and social-based acculturation were associated with stroke/TIA and retained further. A higher number of SDOH was directly associated with all individual VRFs investigated, except for at-risk alcohol, and with number of VRFs (β=0.11, 95% confidence interval [CI]=0.09-0.14). In the fully adjusted model, income, discrimination, social support, chronic stress, and employment status were individually associated with stroke/TIA; the odds of stroke/TIA were 2.3 times higher in individuals with 3 SDOH (95% CI 1.6-3.2) and 2.7 times (95% CI 1.9-3.7) for those with ≥5 versus ≤1 SDOH.

CONCLUSION

Among Hispanic/Latino adults, a higher number of SDOH is associated with increased odds for stroke/TIA and VRFs. The association remained significant after adjustment for VRFs, suggesting involvement of non-vascular mechanisms.

Newcomer Women's Experiences with Perinatal Care During the Three-Month Health Insurance Waiting Period in Ontario, Canada

BACKGROUND

The three-month health insurance waiting period in Ontario reinforces health inequities for newcomer women and their babies. Little is known about the systemic factors that shape newcomer women's experiences during the OHIP waiting period.

PURPOSE

To examine the factors that shaped newcomer women's experiences with perinatal care during the three-month health insurance waiting period in Ontario, Canada.

METHODS

This qualitative study was informed by an intersectional framework, and guided by a critical ethnographic method. Individual interviews were conducted with four newcomer women and three perinatal healthcare professionals. Participant observations at recruitment and interview sites were integral to the study design.

RESULTS

The key systemic factors that shaped newcomer women's experiences with perinatal care included social identity, migration, and the healthcare system. Social identities related to gender, race, and socio-economic status intersected to form a social location, which converged with newcomer women's experiences of social isolation and exclusion. These experiences, in turn, intersected with Ontario's problematic perinatal health services. Together, these factors form systems of oppression for newcomer women in the perinatal period.

CONCLUSIONS

Given the health inequities that can result from these systems of oppression, it is important to adopt an upstream approach that is informed by the Human Rights Code of Ontario to improve accessibility to and the experiences of perinatal care for newcomer women.

Acute and Chronic Stress Associations With Blood Pressure: An Ecological Momentary Assessment Study on an App-Based Platform

OBJECTIVE

This study examined the within- and between-person associations of acute and chronic stress with blood pressure (BP) and heart rate (HR) using an app-based research platform.

METHODS

We examined data from 31,964 adults (aged 18-90 years) in an app-based ecological momentary assessment study that used a research-validated optic sensor to measure BP.

RESULTS

Within-person associations revealed that moments with (versus without) acute stress exposure were associated with higher systolic (SBP; b = 1.54) and diastolic BP (DBP; b = 0.79) and HR ( b = 1.53; p values < .001). During moments with acute stress exposure, higher acute stress severity than usual was associated with higher SBP ( b = 0.26), DBP ( b = 0.09), and HR ( b = 0.40; p values < .05). During moments without acute stress, higher background stress severity than usual was associated with higher BP and HR (SBP: b = 0.87, DBP: b = 0.51, HR: b = 0.69; p values < .001). Between-person associations showed that individuals with more frequent reports of acute stress exposure or higher chronic stress severity had higher SBP, DBP, and HR ( p values < .05). Between-person chronic stress severity moderated within-person physiological responses to stress such that individuals with higher chronic stress severity had higher average BP and HR levels but showed smaller responses to momentary stress.

CONCLUSIONS

Technological advancements with optic sensors allow for large-scale physiological data collection, which provides a better understanding of how stressors of different timescales and severity contribute to momentary BP and HR in daily life.

The Moderated Mediation Effect of Age and Relaxation on the Relationship between the Type A Behavior Pattern and Blood Pressure in South Korea

Although it is generally known that the type A behavior pattern (TABP) is associated with high blood pressure, recent studies have not consistently supported this association. Therefore, it is important to determine which factors moderate and mediate this relationship. The purpose of this study was to verify the moderated mediation effect of age and relaxation in the relationship between TABP and high blood pressure among middle-aged adults in South Korea. This study utilized data from the Korea Health and Genome Study (KHGS) supported by the Korea National Institute of Health. The participants in the present study were 10,022 Korean adults aged 40 to 69. To identify the conditional indirect effect of TABP on blood pressure through relaxation, with a consideration of age, a moderated mediation model using SPSS PROCESS macro 3.10 was applied. As is generally known, TABP was associated with high blood pressure, but its relevance was reversed through relaxation. Moreover, this relationship was moderated by age, which is known to be the most powerful predictor of high blood pressure. The lower age group with TABP exhibited a higher relaxation, whereas the higher age group with TABP demonstrated a lower relaxation. The findings demonstrate the need for relaxation education, stress management, or counseling to help individuals recognize their behavior patterns and strengthen the willingness and motivation for relaxation, especially among elderly people with TABP, in order to manage their blood pressure effectively.

Indirect Effects of Racial Discrimination on Health Outcomes Through Prefrontal Cortical White Matter Integrity

BACKGROUND

Racial discrimination is consistently associated with adverse health outcomes and has been linked to structural decrements in brain white matter. However, it is unclear whether discrimination-related neuroplastic changes could indirectly affect health outcomes. Our goal was to evaluate indirect associations of racial discrimination on health outcomes through white matter microstructure in a sample of trauma-exposed Black women.

METHODS

A trauma study in an urban hospital setting recruited 79 Black women who received a history and physical examination to assess medical disorders (compiled into a summed total of disorder types). Participants reported on experiences of racial discrimination and underwent diffusion tensor imaging; fractional anisotropy values were extracted from white matter pathways previously linked to racial discrimination (corpus callosum, including the body and genu; anterior cingulum bundle; and superior longitudinal fasciculus) and entered into mediational models.

RESULTS

Indirect effects of racial discrimination on medical disorders through left anterior cingulum bundle fractional anisotropy were significant (β = 0.07, SE = 0.04, 95% CI [0.003, 0.14]) after accounting for trauma and economic disadvantage. Indirect effects of racial discrimination on medical disorders through corpus callosum genu fractional anisotropy were also significant (β = 0.08, SE = 0.04, 95% CI [0.01, 0.16]).

CONCLUSIONS

Racial discrimination may increase risk for medical disorders via neuroplastic effects on microstructural integrity of stress-sensitive prefrontal white matter tracts. Racial discrimination-related changes in these tracts may affect health behaviors, which, in turn, influence vulnerability for medical disorders. These data highlight the connections between racial discrimination, prefrontal white matter connections, and incidence of medical disorders in Black Americans.

Association between flexibility activity and blood-pressure change among older adults in Japan: A 5-year longitudinal study

This longitudinal study examined the relationship between flexibility-activity and blood-pressure (BP) change among older adults in Japan. Our study included 452 older adults who took part in our survey in both 2012/2013 and 2017/2018. The seated systolic blood pressure (SBP) and diastolic BP (DBP) were measured both at baseline and at the 5 years follow-up. The frequencies of the different physical activities at baseline were assessed using a questionnaire. A generalized linear mixed model was used to estimate the non-standardized coefficient (B) of BP change associated with flexibility activity, after adjustments for sex, age, body mass index, smoking status, alcohol consumption, antihypertensive medication use, history of heart disease, walking time, and muscle-strengthening activity as a fixed-effect, and area of residence as a random-effect. Higher flexibility-activity frequency was significantly associated with reduced SBP (B = -0.77 [95% confidence intervals = -1.36, -0.18], p for linear trend = 0.01, p for quadratic trend = 0.85) and DBP (-0.33 [-0.71, 0.05], p for linear trend = 0.09, p for quadratic trend = 0.04). Engaging in flexibility activity for 5 days per week was significantly associated with a reduction in DBP (B = -4.16, 95% CI [-7.53, -0.79], p = 0.02) compared with that in the reference group (0 days per week). Interaction tests were not significant between basic variables (sex, age, BMI, and antihypertensive medication) and flexibility. In conclusion, higher flexibility activity frequency was associated with a reduction in BP in older adults. Future longitudinal and interventional studies should examine the effects of flexibility activity on cardiovascular disease prevention.

Predictors of Psychological Strain and Allostatic Load in Teachers: Examining the Long-Term Effects of Biopsychosocial Risk and Protective Factors Using a LASSO Regression Approach

Teacher stress significantly challenges teachers' health, teaching quality, and students' motivation and achievement. Thus, it is crucial to identify factors that effectively prevent it. Using a LASSO regression approach, we examined which factors predict teachers' psychological strain and allostatic load over two years. The study included 42 teachers (28 female, Mage = 39.66, SD = 11.99) and three measurement time points: At baseline, we assessed teachers' (a) self-reports (i.e., on personality, coping styles, and psychological strain), (b) behavioral data (i.e., videotaped lessons), and (c) allostatic load (i.e., body mass index, blood pressure, and hair cortisol concentration). At 1- and 2-year follow-ups, psychological strain and allostatic load biomarkers were reassessed. Neuroticism and perceived student disruptions at baseline emerged as the most significant risk factors regarding teachers' psychological strain two years later, while a positive core self-evaluation was the most important protective factor. Perceived support from other teachers and the school administration as well as adaptive coping styles were protective factors against allostatic load after two years. The findings suggest that teachers' psychological strain and allostatic load do not primarily originate from objective classroom conditions but are attributable to teachers' idiosyncratic perception of this environment through the lens of personality and coping strategies.

The Black-White Disparity in Preterm Birth: Race or Racism?

Policy Points Racism is an upstream determinant of health that influences health through many midstream and downstream factors. This Perspective traces multiple plausible causal pathways from racism to preterm birth. Although the article focuses on the Black-White disparity in preterm birth, a key population health indicator, it has implications for many other health outcomes. It is erroneous to assume by default that underlying biological differences explain racial disparities in health. Appropriate science-based policies are needed to address racial disparities in health; this will require addressing racism.

Stress and social isolation, and its relationship to cardiovascular risk in young adults with intellectual disability

PURPOSE

Stress produces many physiological changes, some of which may contribute to the development of cardiovascular disease (CVD). Individuals with intellectual disability (ID) are exposed to multiple and stressful challenges everyday which may put them at increased cardiovascular risk. This current study aimed to establish whether adults with ID experience higher levels of subjective stress and encounter different stressors (including social isolation) than the general population, and whether there is a relationship between stress and cardiometabolic profile in this population.

METHODS

Adults with ID (n = 35) aged 18-45 years completed the Subjective Stress Survey, and underwent a physiological assessment to measure blood pressure, metabolic profile and subclinical CVD risk factors, and were compared to a control group (n = 29). Multiple regression was used to investigate whether cardiometabolic parameters were predicative of SSS scores.

RESULTS

Findings showed adults with ID have higher perceived stress levels (total score ID: 21.3 ± 11.4 vs control: 13.9 ± 9.0, p = 0.006), which is elicited by unique stressors, when compared to people without ID. Stress was strongly associated with increased social isolation (r = -0.38, p = 0.002) and with obesity in females with mild ID (r = 0.72). Regression showed that arterial stiffness was predictive of total SSS score (p = 0.038).

CONCLUSIONS

Adults with ID aged 18-45 years report higher levels of perceived stress when compared to people without ID.Implications for RehabilitationReducing stress in this young population may prevent development of arterial stiffness, and consequently lower the risk of cardiometabolic morbidity and mortality.There are unique targets for stress management in young adults with intellectual disability, including supporting decision-making and improving self-efficacy.Improving community integration and reducing social isolation may decrease perceived stress in young adults with intellectual disability.

Identifying the Social Determinants of Treated Hypertension in New and Established Latino Destination States

Little is known about the influence of social and environmental contexts on Latino hypertension-related disparities. This study examined the influence of social determinants of cardiovascular health on medically treated hypertension, contrasting established vs. new Latino destination states. Logistic regression models were fitted to analyze 2017 Behavioral Risk Factors Surveillance Survey data from 8,999 Latinos. Overall, 70.4% indicated having treated hypertension. History of diabetes (OR = 2.60) and access to healthcare (OR = 2.38) were associated with treated hypertension, regardless of destination state. In established destinations, Latinos who graduated high school (OR = 1.19) or attended college (OR = 1.32) had higher odds of treated hypertension; whereas those who completed college were less likely to have treated hypertension (OR = 0.80). In contrast, in both new and non-destination states, the odds of treated hypertension were consistently lower across levels of educational attainment. Results highlight the need for cardiovascular-risk reduction interventions to incorporate the social and environmental context in the development process.

Association of walkability and fine particulate matter with chronic obstructive pulmonary disease: A cohort study in China

BACKGROUND

Walkability has been considered to be associated with metabolic and cardiovascular diseases, but the relationship between walkability and chronic obstructive pulmonary disease (COPD) remains unclear. Moreover, fine particulate matter (PM_2.5), possibly positively correlated to walkability, may lead to an increased risk of COPD. The separate and joint effects of PM_2.5 and walkability on risk of COPD were explored in our study.

METHODS

We used prospective data of 29,572 participants from the Yinzhou cohort in Ningbo, China. COPD cases were diagnosed based on the Yinzhou Health Information System (YHIS). Walkability was measured using walk score in relation to the built environment based on geographic information systems (GIS). Air pollution levels were assessed by fitting land use regression (LUR) models. Cox proportional hazards models were used to evaluate the relationships of PM_2.5 and walkability with COPD. Furthermore, we also examined additive and multiplicative interactions between walkability and PM_2.5.

RESULTS

Overall, a total of 29,572 participants were included in the final analysis and 722 COPD incident cases were identified during 134,846 person-years of follow-up. Compared with subjects with lower walkability, individuals with higher walkability had a decreased risk of COPD (HR = 0.88, 95 % CI: 0.82-0.95) for every IQR increase. By contrast, exposure to PM_2.5 (every IQR increase) was associated with an elevated risk of COPD (HR = 1.21, 95 % CI: 1.06-1.37). No interaction between PM_2.5 and walkability was observed.

CONCLUSIONS

Living in a highly walkable neighborhood could decrease risk of COPD, whereas high levels of PM_2.5 were positively associated with COPD. In addition, the beneficial effects of walkability were not attenuated by exposure to PM_2.5.

Genetic and stress influences on the prevalence of hypertension among hispanics/latinos in the hispanic community health study/study of latinos (HCHS/SOL)

PURPOSE

The current study examined the effects of chronic stress and a genetic risk score on the presence of hypertension and elevated systolic blood pressure and diastolic blood pressure among Hispanics/Latinos in the target population of Hispanic Community Health Study/Study of Latinos.

MATERIALS AND METHODS

Of the participants (N = 11,623) assessed during two clinic visits (Visit 1 2008-2013 & Visit 2 2014-2018), we analysed data from 7,429 adults (50.4% female), aged 18-74, who were genotyped and responded to chronic stress questionnaires. We calculated an unweighted genetic risk score using blood pressure increasing single nucleotide polymorphisms (SNPs) found to be generalisable to Hispanics/Latinos (10 SNPs). Linear and logistic regression models were used to estimate associations between chronic stress and genetic risk score and their interaction, with prevalent Visit 2 SBP or DBP, and hypertension, respectively. Models accounted for sampling weights, stratification, and cluster design.

RESULTS

Chronic stress (adjusted OR = 1.18, 95%CI:1.15,1.22) and hypertension genetic risk score (adjusted OR = 1.04, 95%CI:1.01,1.07) were significantly associated with prevalent hypertension, but there was no significant interaction between the chronic stress and genetic risk score on hypertension (p = .49). genetic risk score (b = .32, 95%CI:.08, .55, R² = .02) and chronic stress (b = .45, 95%CI:.19, .72, R² = .11) were related to DBP, with no significant interaction (p = .62). Genetic risk score (b = .42, 95%CI:.08, .76, R² = .01) and chronic stress (b = .80, 95%CI:.34,1.26, R² = .11) were also related to SBP, with no significant interaction (p = .51).

CONCLUSION

Results demonstrate the utility of a genetic risk score for blood pressure and are consistent with literature suggesting chronic stress has a strong, direct association with elevated blood pressure among U.S. Hispanics/Latinos.

Gender Differences in the Indirect Effect of Psychosocial Work Environment in the Association of Precarious Employment and Chronic Stress: A Cross-Sectional Mediation Analysis

Gender differences in the association between precarious employment and chronic stress have been found but the mechanisms underlying this relationship have not been explored. The main objective of this study was to evaluate the mediating effects of psychosocial risk factors at work (i.e., demands, control, and support) and work-life conflicts in the relationship between precarious employment and chronic stress as measured through the production of steroid hormones (both adrenal and gonadal) for men and women separately. Cross-sectional data were derived from a sample of workers from Barcelona (n = 125-255 men; 130 women). A set of 23 markers were determined from hair samples to evaluate the production of both adrenal and gonadal steroids. Decomposition analyses were applied to estimate the indirect effects of psychosocial risk factors and work-life conflict using linear regression models. Gender differences in the association between precarious employment and steroids production were confirmed. Psychosocial risk factors and work-life conflicts had indirect effects only among women (β_Cortisol = 0.18; 95% CI: 0.04-0.32; β_{Cortisol/Cortisone} 0.19; 95% CI: 0.08-0.31; β_%Cortisol 0.12; 95% CI: 0.05-0.20). Gender differences suggest that the physiological response to precarious employment could be determined by the social construction of gender identities, as well as by positions and roles in the labour market and family. Future studies should delve further into these differences to improve employment and working policies, thus mitigating gender inequalities in the labour market to prevent work-related stress.

Maternal perinatal hypertensive disorders and parenting in infancy

Maternal mental health strongly influences parenting during infancy. However, it is unclear whether maternal physical health conditions in the perinatal period may also impact parenting. Examining the association of hypertensive disorders - a common physical health problem in pregnancy - with subsequent parenting behaviors is an important first step in understanding the connection between maternal physical health and parenting during this critical developmental period. This study evaluated whether hypertensive disorders of pregnancy (HDP) and hypertensive disorders (HD) diagnosed after the birth of the infant were associated with parenting self-efficacy, parenting stress, and observed parental responsiveness during mother-infant interactions at 6 and 12 months postpartum among a sample of racially and ethnically diverse mothers and their infants (N = 295). Results showed that mothers with an HDP or HD diagnosis had lower levels of parenting self-efficacy, higher levels of parenting stress, and lower levels of observed parental responsiveness compared to mothers without an HDP or HD diagnosis. Given that women with childhood adversity are at higher risk for experiencing HDP/HD and may have more difficulties with parenting compared to women without childhood adversity, we utilized a sample of mothers wherein most had experienced at least one form of adversity in their childhoods. Exploratory analyses revealed that HDP/HD moderated the relation between early life experiences and parenting outcomes in all but one model. Associations between HDP/HD and parenting are discussed, with implications for how we understand maternal physical health as a determinant of parenting in the perinatal period.

The relationship between tooth loss and hypertension: a systematic review and meta-analysis

As tooth loss is the high end of periodontal problems and edentulous individuals are at higher risk of nutritional problems like obesity, understanding the association between tooth loss and hypertension is important for improving cardiovascular health. We searched for publications from the last two decades using three electronic databases (PubMed, Web of Science and Scopus) and conducted a systematic review and meta-analysis on the association between tooth loss and hypertension according to PRISMA-P guidelines. Quality assessments were performed using the Newcastle–Ottawa Scale and the GRADE approach. Twenty-four studies (20 cross-sectional, and 4 cohort) met the inclusion criteria for this review. Most cross-sectional studies showed that subjects with more tooth loss exhibited a greater proportion of hypertension and higher systolic blood pressure than those with less tooth loss. Meta-analyses revealed a statistically significant association between tooth loss and hypertension. The pooled odds ratios of hypertension for having tooth loss with no tooth loss and for edentulous with dentate were 2.22 (95% CI 2.00–2.45) and 4.94 (95% CI 4.04–6.05), respectively. In cohort studies, subjects with more tooth loss had a greater incidence of hypertension than those with less tooth loss during the follow-up period. The present systematic review and meta-analysis suggests that tooth loss is associated with an increased risk of hypertension and higher systolic blood pressure.

Association of marital status with cognitive function in Chinese hypertensive patients: a cross-sectional study

PURPOSE

The aim of this study was to evaluate the association of marital status with cognitive function and to examine the potential effect modifiers in Chinese hypertensive populations.

METHODS

A total of 9,525 adult Chinese hypertensive patients were enrolled in this cross-sectional study. Cognitive function, as the dependent variable in our study, was assessed by the Chinese version of the Mini-Mental State Examination (MMSE). We adjusted for potential confounding factors in multiple linear regression models to examine the relationship of marital status with cognitive function. In addition, we divided the population according to sex to explore whether there were sex-specific differences.

RESULTS

Among the 9,525 study participants, the mean (SD) age for men was 63.5 (10.3) years, and the mean MMSE score was 24.9 ± 5.0, whereas for women, the mean (SD) age was 63.8 (9.3) years, and the mean MMSE score was 19.4 ± 6.4. Unmarried persons had lower scores on the MMSE and lower subscores in each of the cognitive domains. A stronger correlation between marital status and a lower MMSE score was statistically significant in men (unmarried men: β = -1.55; 95% CI: -1.89, -1.21) but not women (unmarried women: β = -0.22; 95% CI: -0.56, 0.12; p interaction = 0.006). Compared to men who were widowed or divorced, never married men were more likely to have lower MMSE scores (β = -2.30, 95% CI -3.10,-1.50; p < 0.001).

CONCLUSIONS

Our study demonstrated that being unmarried is an extremely important but neglected social risk factor for cognitive function. Sex was a strong effect modifier: being unmarried was correlated with a higher risk of cognitive decline than being married in Chinese hypertensive men, especially among older men, but this correlation was not observed among women. Moreover, never married men showed poorer cognitive function than those who were divorced or widowed.

The Effect of Aromatherapy on Blood Pressure and Stress Responses by Inhalation and Foot Massage in Patients With Essential Hypertension: Randomized Clinical Trial

A 3-arm, parallel group, randomized clinical trial examines the effect of aromatherapy through inhalation and foot massage on blood pressure and stress response in patients with essential hypertension. Lavender oil reduced blood pressure, heart rate, serum cortisol, and subjective anxiety in hypertensive patients.

Evaluation of bi-directional causal association between depression and cardiovascular diseases: a Mendelian randomization study

BACKGROUND

Depression and cardiovascular disease (CVD) are associated with each other but their relationship remains unclear. We aim to determine whether genetic predisposition to depression are causally linked to CVD [including coronary artery disease (CAD), myocardial infarction (MI), stroke and atrial fibrillation (AF)].

METHODS

Using summary statistics from the largest genome-wide association studies (GWAS) or GWAS meta-analysis of depression (primary analysis: n = 500 199), broad depression (help-seeking behavior for problems with nerves, anxiety, tension or depression; secondary analysis: n = 322 580), CAD (n = 184 305), MI (n = 171 875), stroke (n = 446 696) and AF (n = 1 030 836), genetic correlation was tested between two depression phenotypes and CVD [MI, stroke and AF (not CAD as its correlation was previously confirmed)]. Causality was inferred between correlated traits by Mendelian Randomization analyses.

RESULTS

Both depression phenotypes were genetically correlated with MI (depression: r_G = 0.169; p = 9.03 × 10^-9; broad depression: r_G = 0.123; p = 1 × 10^-4) and AF (depression: r_G = 0.112; p = 7.80 × 10^-6; broad depression: r_G = 0.126; p = 3.62 × 10^-6). Genetically doubling the odds of depression was causally associated with increased risk of CAD (OR = 1.099; 95% CI 1.031-1.170; p = 0.004) and MI (OR = 1.146; 95% CI 1.070-1.228; p = 1.05 × 10^-4). Adjustment for blood lipid levels/smoking status attenuated the causality between depression and CAD/MI. Null causal association was observed for CVD on depression. A similar pattern of results was observed in the secondary analysis for broad depression.

CONCLUSIONS

Genetic predisposition to depression may have positive causal roles on CAD/MI. Genetic susceptibility to self-awareness of mood problems may be a strong causal risk factor of CAD/MI. Blood lipid levels and smoking may potentially mediate the causal pathway. Prevention and early diagnosis of depression are important in the management of CAD/MI.

The Association Between Life Events and Incidence of Hypertension Among Government Employees in China: A Prospective Cohort Study

Background

Hypertension (HTN) is a global public health concern. However, the association between life events (LEs) and HTN is complex. Thus, we conducted a prospective cohort study to explore this complex association.

Methods

A total of 8,077 government employees without HTN were recruited through cluster sampling between 2018 and 2019 in Hunan Province, China. At baseline, information regarding sociodemographic characteristics, LEs, and behavioral factors was collected. After the 1-year follow-up, the participants were revisited to obtain the HTN diagnosis. Crude and adjusted Poisson regression models were constructed to calculate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Cubic regression spline models were used to visualize the trends between LEs and HTN IRRs. Interactive and subgroup analyses were also performed.

Results

The 1-year HTN incidence rate among government employees in Hunan province was 4.30% (95% CI: 3.86-4.74%). LEs were associated with a higher HTN risk (IRR, 1.02; 95% CI, 1.00-1.04). When calculating positive and negative LEs scores separately, only the latter was a risk factor for HTN incidence (IRR, 1.04; 95% CI, 1.03-1.06); conversely, positive LEs reduced the risk (IRR, 0.90; 95% CI, 0.85-0.96). Compared with patients in the lowest quartile of LEs score, those in quartiles two (IRR, 1.28; 95% CI, 0.96-1.71), three (IRR, 1.43; 95% CI, 1.04-1.96), and four (IRR, 1.73; 95% CI, 1.26-2.37) were at progressively higher risk. In restricted spline curves, a non-linear association was noted between LEs and HTN risk. Regarding the subcategories of LEs, work-related LEs, personal LEs, and all subcategories of negative LEs were associated with an increased risk of HTN. However, among positive LEs, only the family-related cases were associated with a lower risk of HTN.

Conclusion

LEs had a non-linear association with an increased risk of HTN. Negative LEs were risk factors for HTN incidence, whereas positive LEs reduced the risk of HTN. Thus, the importance of LEs should be highlighted in the development of HTN prevention strategies and initiatives.

Blood pressure control status of patients with hypertension on treatment in Dessie City Northeast Ethiopia

INTRODUCTION

Uncontrolled blood pressure contributes a huge contribution to many hypertension-related complications and it is one of the unbeaten problems for patients taking antihypertensive drugs. The association of social support and other factors with uncontrolled blood pressure during the covid-19 pandemic is not well investigated. Therefore, this study explored the determinants of blood pressure control status during the COVID-19 pandemic among patients with hypertension who were on an antihypertensive treatment.

METHOD

A cross-sectional study was done from March to May 2021 among adults aged 18 or more patients with hypertension for three months or more on treatment in Dessie City. An interview-administered questionnaire was done using simple random sampling from hypertension follow-up register for 380 patients with hypertension. Blood pressure measurement was taken from their arm using a stethoscope and mercury sphygmomanometer at a sitting position with 90-degree back support. Uncontrolled blood pressure was also computed either the systolic or diastolic blood pressure greater than or less than the limit of uncontrolled blood pressure with regarding the age and diabetic status of patients. The perceived social support-related questionnaire was adopted from the Multidimensional Scale of Perceived Social Support (MSPSS) -12 item checklist. It was sum-up and transformed into three categories using tertile of their computed raw scores. The adjusted prevalence ratio with a 95 percent confidence interval (CI) was used to calculate the strength of the association between uncontrolled blood pressure and independent predictors using log-binomial regression analysis. A P-value less than 0.05 was declared as statistically significant in multivariable log-binomial regression analysis.

RESULT

A total of 360 study participants were included in this study. The prevalence of uncontrolled blood measures in patients with hypertension with a 95% CI was 55.8(50.7, 61.0). In a multivariable analysis adjusted prevalence ratio with 95% CI for poor medication adherence 1.86(1.59,2.19), being male 1.35(1.11,1.64), secondary education 0.52(0.35,0.77), and low social support 1.24(1.01, 1.54) were the predictors of uncontrolled blood pressure.

CONCLUSION

Uncontrolled blood pressure for patients with hypertension on treatment is higher during the COVID-19 pandemic. Being male, poor medication adherence, educational status and low social support are factors that contribute to uncontrolled blood pressure.

Stressful life events, neighbourhood characteristics, and systolic blood pressure in South Africa

The relationship between negative events, neighbourhood characteristics, and systolic blood pressure in developing countries is not well-documented, particularly using longitudinal data. To explore this relationship, we analysed panel data from the first three waves of the South African National Income Dynamics Study using a correlated random effects model adjusted for confounding risk factors. Our sample comprised of 15,631 respondents in 2008, 14,443 respondents in 2010/2011, and 14,418 respondents in 2012, all aged above 15 years. The prevalence of at least one negative household event across the three waves was approximately 30%. In any of the three waves, the adjusted prevalence of hypertension was 23.84%. This share was 21.75% in 2008 (95% CI 18.06-25.44), 23.16% in 2010/11 (95% CI 19.18-27.14), and 18.39% in 2012 (95% CI 16.03-20.75). In our adjusted correlated random effects model, we found that systolic blood pressure was significantly higher among respondents from households that reported death of a household member (0.85 mmHg; p =  0.02) and a reduction in grant income and remittances (2.14 mm Hg; p = 0.01). We also found no significant association between systolic blood pressure and neighbourhood income level. In a country with social and economic challenges, our results indicate that grief and negative financial events are adversely associated with blood pressure, which may explain in part the significant burden of hypertension in low- and middle-income countries.

Microbial ecology and evolution is key to pandemics: using the coronavirus model to mitigate future public health challenges

Pandemics are global challenges that lead to total disruption of human activities. From the inception of human existence, all pandemics have resulted in loss of human lives. The coronavirus disease caused by SAR-CoV-2 began in China and is now at the global scale with an increase in mortality and morbidity. Numerous anthropogenic activities have been implicated in the emergence and severity of pandemics, including COVID-19. These activities cause changes in microbial ecology, leading to evolution due to mutation and recombination. This review hypothesized that an understanding of these anthropogenic activities would explain the dynamics of pandemics. The recent coronavirus model was used to study issues leading to microbial evolution, towards preventing future pandemics. Our review highlighted anthropogenic activities, including deforestation, mining activities, waste treatment, burning of fossil fuel, as well as international travels as drivers of microbial evolution leading to pandemics. Furthermore, human-animal interaction has also been implicated in pandemic incidents. Our study recommends substantial control of such anthropogenic activities as having been highlighted as ways to reduce the frequency of mutation, reduce pathogenic reservoirs, and the emergence of infectious diseases.

Prevalence of Hypertension and Related Characteristics: Perspectives from an Outpatient Podiatric Medical Clinic

BACKGROUND

Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the outpatient podiatric medical clinic setting and to determine the relevance of hypertension risk factors in this setting.

METHODS

A survey tool was created to characterize relevant risk factors, and systolic and diastolic blood pressures were recorded. Descriptive statistics were generated after conclusion of enrollment. Analysis was also performed to determine the relationship between individual risk factors and systolic blood pressure.

RESULTS

Of the 176 patients, 56 (31.8%) had an incidentally high blood pressure at intake, including 18.5% of patients without a known history of hypertension and 38.5% with a known history of hypertension. Three risk factors were found to be significantly associated with increasing systolic blood pressure: weight (P = .022), stress level (P = .017), and presence of renal artery stenosis (P = .021). There was also a near-statistically significant inverse relationship between systolic blood pressure and amount of time spent exercising (P = .068).

CONCLUSIONS

Overall, a relatively high prevalence of incidental hypertension was identified, including among patients not previously diagnosed as having hypertension. Consideration of risk factors and awareness of the prevalence of the condition can be useful for practitioners, even as they manage presenting podiatric medical concerns. Future investigations may consider interventional or preventive strategies in the outpatient clinic setting.

Does 3D Printing-Assisted Acetabular or Pelvic Fracture Surgery Shorten Hospitalization Durations among Older Adults?

Acetabular or anterior pelvic ring fractures are rare but extremely complicated and challenging injuries for orthopedic trauma surgeons. Three-dimensional (3D) printing technology is widely used in the management of these two fracture types for surgical benefits. Our study aimed to explore whether 3D printing-assisted acetabular or pelvic surgery is beneficial in terms of shortening the length of hospital stay (LHS) and intensive care unit (ICU) stay (ICU LS) for older patients. This retrospective study included two groups of 76 participants over 60 years old who underwent operations with (n = 41) or without (n = 35) guidance by 3D printing. The Mann–Whitney U test was used to analyze continuous variables. Chi-square analysis was applied for categorical variables. Univariable and multivariable linear regression models were used to analyze the factors associated with LHS. The median LHS in the group without 3D printing assistance was 16 (12–21) days, and the median ICU LS was 0 (0–2) days. The median LHS in the group with 3D printing assistance was 17 (12.5–22.5) days, and the median ICU LS was 0 (0–3) days. There was no significant difference in LHS associated with 3D printing assistance vs. that without 3D printing among patients who underwent open reduction and internal fixation for pelvic or acetabular fractures. The LHS positively correlated with the ICU LS whether the operation was 3D printing assisted or not. For fracture surgery in older patients, in addition to the advancement of surgical treatment and techniques, medical teams require more detailed preoperative evaluations, and more personalized medical plans regarding postoperative care to achieve the goals of shortening LHS, reducing healthcare costs, and reducing complication rates.

Leg and arm adiposity is inversely associated with diastolic hypertension in young and middle-aged United States adults

BACKGROUND

We sought to determine the association between appendicular adiposity and hypertension, with the purpose of better understanding the role of body fat distribution on blood pressure (BP).

METHODS

We included 7411 adults aged 20 to 59 who were not taking antihypertensives and without cardiovascular disease from the 2011 to 2018 National Health and Nutrition Examination Surveys. Leg & arm adiposity, determined via dual-energy X-ray absorptiometry scans, was defined as percent of total body fat present in legs/arms (leg/total%, arm/total%). Measures were categorized into sex-specific tertiles. We estimated change in BP and odds ratios (ORs) of hypertension (BP ≥ 130/80) and hypertension subtypes using multivariable, survey design-adjusted linear & logistic regression, respectively.

RESULTS

Of the participants, 49% were female, the average (standard deviation) age was 37.4 (0.3) years, and 24% had hypertension. Those in the highest tertile (T3) of leg/total% had 30% decreased adjusted ORs (aOR) of hypertension compared to the lowest tertile (T1; aOR, 0.70; 95% confidence interval [95% CI], 0.55-0.89). This association was not significant for arm/total% (0.89, 0.68-1.17). T3 of leg/total% was associated with 49% lower, 41% lower, and unchanged relative odds of isolated diastolic hypertension (IDH), systolic-diastolic hypertension (SDH), and isolated systolic hypertension (ISH) compared to T1 (IDH: 0.51, 0.37-0.70; SDH: 0.59, 0.43-0.80; ISH: 1.06, 0.70-1.59). For every 10% increase in leg/total%, diastolic BP decreased by an adjusted mean 3.5 mmHg (95% CI, - 4.8 to - 2.2) in males and 1.8 mmHg (95% CI, - 2.8 to - 0.8) in females (P < 0.001 for both).

CONCLUSIONS

A greater proportional distribution of fat around the legs is inversely, independently associated with hypertension, and more specifically, diastolic hypertension (IDH and SDH).

Influence of Mindfulness and Relaxation on Treatment of Essential Hypertension: Meta-Analysis

Background

Some studies published previously have shown a strong correlation between hypertension and psychological nature including impulsion emotion or mindfulness and relaxation temperament, among which mindfulness and relaxation temperament might have a benign influence on blood pressure, ameliorating the hypertension. However, the conclusion was not confirmed.

Objective

The meta-analysis was performed to investigate the influence of mindfulness and relaxation on essential hypertension interventions and confirm the effects.

Methods

Systematic searches were conducted in common English and Chinese electronic databases (i.e., PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, Cochrane Library, and Chinese Biomedical Literature Database) from 1980 to 2020. A meta-analysis including 5 studies was performed using Rev Man 5.4.1 software to estimate the influence of mindfulness and relaxation on blood pressure, ameliorating the hypertension. Publication bias and heterogeneity of samples were tested using a funnel plot. Studies were analyzed using either a random-effect model or a fixed-effect model.

Results

All the 5 studies investigated the influence of mindfulness and relaxation on diastolic and systolic blood pressure, with total 205 participants in the control group and 204 in the intervention group. The random-effects model (REM) was used to calculate the pooled effect for mindfulness and relaxation on diastolic blood pressure (I 2 = 0%, t 2 = 0.000, P=0.41). The random pooled effect size (MD) was 0.30 (95% CI = -0.81-1.42, P=0.59). REM was used to calculate the pooled effect for mindfulness and relaxation on systolic blood pressure (I 2 = 49%, t 2 = 3.05, P=0.10). The random pooled effect size (MD) was -1.05 (95% CI = -3.29-1.18, P=0.36). The results of this meta-analysis were influenced by publication bias to some degree.

Conclusion

All the results showed less influence of mindfulness and relaxation might act on diastolic or systolic blood pressure, when mindfulness and relaxation are used to intervene in treating CVD and hypertension.

Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy

OBJECTIVE

Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship.

STUDY DESIGN

A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 20^6/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP.

RESULTS

Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06-2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03-2.20). No mediation effect by inflammation was observed.

CONCLUSION

Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP.

KEY POINTS

· This study was conducted to determine if women with high levels of psychosocial stress have differences in risk for hypertensive disorders of pregnancy (HDP).. · Independent of known risk factors, women with increased lifetime psychosocial burden are at higher risk for HDP.. · A model that captures multiple domains of life stress may better predict HDP than a unimodal stress assessment..

Liveable residential space, residential density, and hypertension in Hong Kong: A population-based cohort study

BACKGROUND

Hypertension is a leading preventable risk factor of chronic disease and all-cause mortality. Housing is a fundamental social determinant of health. Yet, little is known about the impacts of liveable residential space and density on hypertension.

METHODS AND FINDINGS

This retrospective observational study (median follow-up of 2.2 years) leveraged the FAMILY Cohort, a large territory-wide cohort in Hong Kong, Special Administrative Region, People's Republic of China to quantify associations of objectively measured liveable space and residential density with blood pressure outcomes among adults aged ≥16 years. Blood pressure outcomes comprised diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), and hypertension. Liveable space was measured as residential floor area, and density was assessed using the number of residential units per building block and neighborhood residential unit density within predefined catchments. Multivariable regression models examined associations of liveable floor area and residential density with prevalent and incident hypertension. We investigated effect modifications by age, sex, income, employment status, and housing type. Propensity score matching was further employed to match a subset of participants who moved to smaller residences at follow-up with equivalent controls who did not move, and generalized linear models examined the impact of moving to smaller residences upon blood pressure outcomes. Our fully adjusted models of prevalent hypertension outcomes comprised 30,439 participants at baseline, while 13,895 participants were available for incident models at follow-up. We found that each interquartile range (IQR) increment in liveable floor area was associated with lower DBP (beta [β] = -0.269 mm Hg, 95% confidence interval [CI]: -0.419 to -0.118, p < 0.001), SBP (β = -0.317 mm Hg, -0.551 to -0.084, p = 0.008), MAP (β = -0.285 mm Hg, -0.451 to -0.119 with p < 0.001), and prevalent hypertension (odds ratio [OR] = 0.955, 0.918 to 0.993, p = 0.022) at baseline. Each IQR increment in residential units per building block was associated with higher DBP (β = 0.477 mm Hg, 0.212 to 0.742, p = <0.001), SBP (β = 0.750 mm Hg, 0.322 to 1.177, p = <0.001), MAP (β = 0.568 mm Hg, 0.269 to 0.866, p < 0.001), and prevalent hypertension (OR = 1.091, 1.024 to 1.162, p = 0.007). Each IQR increase in neighborhood residential density within 0.5-mi street catchment was associated with lower DBP (β = -0.289 mm Hg, -0.441 to -0.137, p = <0.001), SBP (β = -0.411 mm Hg, -0.655 to -0.168, p < 0.001), MAP (β = -0.330 mm Hg, -0.501 to -0.159, p = <0.001), and lower prevalent hypertension (OR = 0.933, 0.899 to 0.969, p < 0.001). In the longitudinal analyses, each IQR increment in liveable floor area was associated with lower DBP (β = -0.237 mm Hg, -0.431 to -0.043, p = 0.016), MAP (β = -0.244 mm Hg, -0.444 to -0.043, p = 0.017), and incident hypertension (adjusted OR = 0.909, 0.836 to 0.988, p = 0.025). The inverse associations between larger liveable area and blood pressure outcomes were more pronounced among women and those residing in public housing. In the propensity-matched analysis, participants moving to residences of lower liveable floor area were associated with higher odds of incident hypertension in reference to those who did not move (OR = 1.623, 1.173 to 2.199, p = 0.002). The major limitations of the study are unmeasured residual confounding and loss to follow-up.

CONCLUSIONS

We disentangled the association of micro-, meso-, and macrolevel residential densities with hypertension and found that higher liveable floor area and neighborhood scale residential density were associated with lower odds of hypertension. These findings suggest adequate housing in the form of provisioning of sufficient liveable space and optimizing residential density at the building block, and neighborhood levels should be investigated as a potential population-wide preventive strategy for lowering hypertension and associated chronic diseases.

Effect of Yoga on Blood Pressure in Prehypertension: A Systematic Review and Meta-Analysis

Introduction

Prehypertension is a precursor for developing hypertension and is a risk factor for cardiovascular diseases. Yoga therapy may have a role in lowering the blood pressures in prehypertension and hypertension. This systematic review aims to synthesize the available literature for the same. Methodology. Databases such as PubMed, Embase, Scopus, and Web of Science were searched for randomised control trials only in the time duration of 2010–2021. The main outcome of interest was systolic and diastolic blood pressures. Articles were screened based on the inclusion criteria, and 8 articles were recruited for the review. Meta-analysis was done for suitable articles. RevMan 5.4 by Cochrane was used for meta-analysis and forest plot construction. Risk of bias was determined using the Downs and Black checklist by three independent authors.

Results

The meta-analysis of the articles favoured yoga intervention over the control intervention. Yoga therapy had significantly reduced the systolic pressure (−0.62 standard mean difference, at IV fixed 95% CI: −0.83, −0.41) and diastolic pressure (−0.81 standard mean difference, at IV random 95% CI: −1.39, −0.22). Secondary outcome measures studied were heart rate, weight, BMI, waist circumference, and lipid profile. The main protocol of yoga therapy included postures, breathing exercises, and different meditation techniques. A significant reduction in secondary outcomes was observed, except for HDL values in lipid profile which showed a gradual increase in yoga group in comparison with alternative therapy.

Conclusion

Yoga therapy has shown to be significant in the reduction of systolic and diastolic pressure in prehypertensive population. Supporting evidence lacks in providing a proper structured dosage of yoga asanas and breathing techniques. Considering the existing literature and evidence, Yoga therapy can be used and recommended in prehypertensive population and can be beneficial in reducing the chances of developing hypertension or cardiovascular diseases.

Urinary Stress Hormones, Hypertension, and Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis

[Figure: see text].

Predictors of preterm birth and low birth weight: A person-centered approach

Objective

Profound disparities exist among Black and White families who experience adverse infant health outcomes, yet much is unclear regarding factors that predict disparate outcomes. In order to address this gap, this study applied a person-centered, intersectional analysis to determine ways that women's typological risk profiles inform risk for preterm birth and low birth weight.

Materials and methods

In order to examine the role that social determinants play in predicting risk, this study implemented a latent class mixture modeling analysis of data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Data were extracted from Pennsylvania and Illinois PRAMS surveys from 2012 to 2015 (n = 4336).

Results

Results of the study indicate three distinct risk types among women in the sample: low-, moderate- and high-risk. Three latent classes were identified: (1) low risk for PTB/LBW (44%); (2) moderate risk (19%); and (3) high risk (36%). Compared to class one, the likelihood of experiencing PTB were significantly higher for class three (x²_PTB = 9.54, p < .001; x²_LBW = 35.51, p < .001). The likelihood of experiencing LBW were significantly higher for class three, compared to class two (x²_PTB = 9.21, p < .05; x²_LBW = 21.17, p < .001).Within the three risk groups, racial disparities are particularly notable, with 76% of the sample's African American mothers falling into the “high-risk” category.

Conclusion

Public and perinatal health researchers, organizations, and funders are increasingly recognizing the need to identify methods that will best support health-promoting interventions that have the potential to close the racial disparity in PTB and LBW. Although racial disparities have long been noted, the findings from this study's analysis help to better understand how determinants of health intersect to create an overarching risk profile, which can be used to inform health interventions and services that may reduce the current Black-White gap in infant health outcomes.

•

Profound race-based infant health disparities exist, yet much is unclear regarding factors that predict disparate outcomes.

•

Disparities-related science has largely neglected theoretical models that could help conceptualize this complex issue.

•

This article drew from a comprehensive theoretical framework to investigate disparities in infant health outcomes.

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

Gender with marital status, cultural differences, and vulnerability to hypertension: Findings from the national survey for noncommunicable disease risk factors and mental health using WHO STEPS in Bhutan

Cardiovascular disease is the leading cause of death in the Kingdom of Bhutan. Thus, the early detection and prevention of hypertension is critical for reducing cardiovascular disease. However, the influence of sociocultural factors on vulnerability to hypertension needs further investigation. This study performed secondary data analysis on 1,909 individuals in a cross-sectional study (the National survey for noncommunicable disease risk factors and mental health using World Health Organization (WHO) STEPS approach in Bhutan- 2014). Multivariate logistic regression demonstrated a significant association between gender with marital status and hypertension. Women had a higher odds ratio than men (Ref) when married (AOR: 1.27, 95% confidence intervals (CI): 1.23-1.31), and when separated, divorced, or widowed (AOR: 1.18, 95% CI: 1.12-1.26). People who speak the Tshanglakha language scored the highest odds (AOR: 1.24, 95% CI: 1.20-1.27), followed by Lhotshamkha (AOR: 1.09, 95% CI: 1.06-1.12) and Dzongkha (Ref) after adjusting for various social and biomedical factors. Additionally, tobacco use displayed decreased odds for hypertension. To promote the early detection and prevention of hypertension, these cultural factors should be considered even within small geographic areas, such as Bhutan. It is necessary to strengthen hypertension preventive strategies for people who speak Tshanglakha and Lhotshamkha. Furthermore, careful consideration should be given to preventing hypertension among adults aged 40 years or more, women who are married, separated, divorced, or widowed, and men who never married in Bhutan.

Perceived stress is related to lower blood pressure in a Swedish cohort

AIMS

General psychosocial stress and job strain have been related to blood pressure (BP) with conflicting results. This study sought to explore the contribution of several lifestyle factors in the relation between general psychosocial stress, job strain and BP.

METHODS

This cross-sectional study investigated the association of general stress and job strain with systolic BP (SBP) and diastolic BP in a sample of 9441 employed individuals from the EpiHealth cohort. General stress was measured by the Perceived Stress Scale. Job strain was assessed with the Job Content Questionnaire, assessing two dimensions of job strain: psychological job demand and decision latitude. Linear regression and sensitivity analysis were performed.

RESULTS

At the uncorrected model, general stress, job demand and decision latitude were all inversely associated with SBP. After further adjustment for lifestyle and health parameters, only general stress was associated with SPB (β coefficient: -0.103; 95% confidence interval -0.182 to 0.023).

CONCLUSIONS

General stress is associated with lower SBP independently of lifestyle in middle-aged adults. Our findings point towards a major contribution for job-unrelated stressors in determining SBP and support the pivotal role of lifestyle behaviours and health status in modulating the effect of stress on BP, calling for a careful selection of confounders.

A Systematic Review of Physical Health Consequences and Acculturation Stress Among Latinx Individuals in the United States

The health of Latinx immigrants decays over time and across generations. Acculturation stress influences decays in behavioral and mental health in this population, but the effect on physical health outcomes is less understood. This systematic review synthesizes findings from 22 studies that examined the influence of acculturation stress on physical health outcomes among Latinx populations in the United States. The Society-to-Cell Resilience Framework was used to synthesize findings according to individual, physiological, and cellular levels. There is mounting evidence identifying acculturation stress as an important social contributor to negative physical health outcomes, especially at the individual level. More research is needed to identify the physiological and cellular mechanisms involved. Interventions are also needed to address the damaging effects of acculturation stress on a variety of physical health conditions in this population.

Prevalence of Cardiovascular Disease Risk Factors by Key Demographic Variables Among Mid-South Church Leaders from 2012 to 2017

Cardiovascular disease (CVD) risk factors were examined among church leaders (n = 2309) who attended Mid-South United Methodist Church annual meetings between 2012 and 2017 using repeated cross-sectional data. There was a significant increase in body mass index (BMI) (b = 0.24, p = 0.001) and significant decreases in blood pressure (systolic: b = - 1.08, p < 0.001; diastolic: b = - 0.41, p = 0.002), total cholesterol (b = - 1.76, p = 0.001), and blood sugar (b = - 1.78, p = 0.001) over time. Compared to Whites, a significant increase was seen in BMI (b = 1.14, p = 0.008) among participants who self-identified as "Other," and a significant increase was seen in blood pressure (systolic: b = 1.36, p = 0.010; diastolic: b = 1.01, p = 0.004) among African Americans over time. Results indicate BMI and blood pressure are important CVD risk factors to monitor and address among church leaders, especially among race/ethnic minority church leaders.

Acute physical and mental stress resulted in an increase in fatty acids, norepinephrine, and hemodynamic changes in normal individuals: A possible pathophysiological mechanism for hypertension-Pilot study

Hypertension is often associated with metabolic changes. The sustained increase in sympathetic activity is related to increased blood pressure and metabolic changes. Environmental stimuli may be related to increased sympathetic activity, blood pressure, and metabolic changes, especially in genetically predisposed individuals. The aim of this study was to evaluate the response of fatty acids to physical and mental stress in healthy volunteers and the hemodynamic, hormonal, and metabolic implications of these stimuli. Fifteen healthy individuals with a mean age of 31 ± 7 years, of both sexes, were evaluated. They were assessed at baseline and after combined physical and mental stress (isometric exercise test, Stroop color test). Blood samples were collected at baseline and after stimulation for glucose, insulin, fatty acid, and catecholamine levels. Blood pressure, heart rate, cardiac output, systemic vascular resistance, and distensibility of the large and small arteries were analyzed. The data obtained at baseline and after stimuli were from the same individual, being the control itself. Compared to baseline, after physical and mental stress there was a statistically significant increase (p < .05) in free fatty acids, norepinephrine, diastolic blood pressure, peripheral vascular resistance, and distensibility of the large and small arteries. In conclusion, the combination of physical and mental stress raised fatty acids, norepinephrine, diastolic blood pressure, and peripheral vascular resistance in healthy individuals.

Effects of diaphragmatic deep breathing exercises on prehypertensive or hypertensive adults: A literature review

Diaphragmatic breathing, a deep breathing technique, has been reported to improve autonomic function by reducing sympathetic activity and increasing baroreflex sensitivity. This literature review aimed to (1) examine the effects of diaphragmatic breathing on physiological and psychological measures in prehypertensive or hypertensive adults and to (2) determine the appropriate length, frequency, and duration of an effective diaphragmatic breathing exercise in the management of prehypertension and hypertension. Relevant studies were searched using electronic databases, and 13 studies that met the inclusion criteria were included. The synthesis of the findings revealed that voluntary diaphragmatic deep breathing resulted in decreased of systolic and diastolic blood pressures, reduced heart rate, a relaxing effect, and reduced anxiety in hypertensive or prehypertensive individuals. It is concluded that voluntary diaphragmatic breathing at <10 or 6 breaths per minute for 10 min twice a day for 4 weeks was effective in producing positive outcomes. The results of this review provide directions for related interventions and future research.

A Variant in the Nicotinic Acetylcholine Receptor Alpha 3 Subunit Gene Is Associated With Hypertension Risks in Hypogonadic Patients

Ephb6 gene knockout causes hypertension in castrated mice. EPHB6 controls catecholamine secretion by adrenal gland chromaffin cells (AGCCs) in a testosterone-dependent way. Nicotinic acetylcholine receptor (nAChR) is a ligand-gated Ca²⁺/Na⁺ channel, and its opening is the first signaling event leading to catecholamine secretion by AGCCs. There is a possibility that nAChR might be involved in EPHB6 signaling, and thus sequence variants of its subunit genes are associated with hypertension risks. CHRNA3 is the major subunit of nAChR used in human and mouse AGCCs. We conducted a human genetic study to assess the association of CHRNA3 variants with hypertension risks in hypogonadic males. The study cohort included 1,500 hypogonadic Chinese males with (750 patients) or without (750 patients) hypertension. The result revealed that SNV rs3743076 in the fourth intron of CHRNA3 was significantly associated with hypertension risks in the hypogonadic males. We further showed that EPHB6 physically interacted with CHRNA3 in AGCCs, providing a molecular basis for nAChR being in the EPHB6 signaling pathway.

The psychometric properties of the Hypertensive Treatment Adherence Scale

BACKGROUND

Hypertension (HTN) is a public concern and treatment adherence has a key role in its management. This study was conducted to develop and test the reliability and validity of the Hypertensive Treatment Adherence scale (HTA-scale).

METHODS

This was a cross-sectional and methodological study. After item generation using a qualitative study and literature review, the scale was developed. The psychometric properties of the scale were evaluated using face, content, construct, and criterion validity and reliability.

RESULTS

Data analysis showed that the HTA-scale had acceptable face and content validity. The scale had excellent stability [Intraclass correlation coefficient (ICC) = 0.74] and good acceptability and internal consistency (Cronbach's a = 0.76). Exploratory factor analysis (EFA) showed that the HTA-scale consisted of 6 meaningful subscales including medication adherence and monitoring, adherence to safe diets, avoiding unsafe diets, self-medication, activity, and smoking. Participants in the controlled blood pressure group had significantly higher HTA-scale scores than the uncontrolled blood pressure group. At the cut-off point of 86, the scale had significant sensitivity and specificity.

CONCLUSION

All of the psychometric properties of the HTA-scale achieved the standard level and were sufficient to recommend this scale for patients with HTN.

Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials

The mindfulness-based stress reduction program (MBSR) may reduce blood pressure (BP) in patients with hypertension or elevated BP. However, some important parameters (such as asleep BP) have not been investigated in previous reviews, and a well-conducted meta-analysis is lacking. This meta-analysis investigates the effect and acceptability of MBSR on patients with elevated BP or hypertension. Relevant articles were searched in multiple databases, including MEDLINE, EMBASE, and APA PsycInfo. Included studies were randomized controlled trials that involved patients with an elevated BP, had a control group, and investigated the effect of MBSR. The mean office and out-of-office (including 24-hour, daytime, and asleep) systolic BP and diastolic BP, psychological outcomes (depression/anxiety/stress), and dropout rate were compared between the MBSR arm and the control arm using a random-effects model. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Twelve studies were included, and only one was considered having low risk of bias. MBSR decreased the office systolic BP and diastolic BP by 6.64 and 2.47 mm Hg at postintervention, respectively; the reduction in diastolic BP was sustained until 3 to 6 months after the recruitment. Our meta-analyses did not find a significant reduction in out-of-office BP after MBSR. MBSR reduced depressive, anxiety, and stress symptoms. The dropout rate from MBSR arm was 15% and was similar to that of control arm. The current evidence is limited by lack of high-quality and adequately powered trials with long-term follow-up. Furthermore, out-of-office BP was only reported by few trials.

A Systematic Review of the Association Between Psychological Stress and Dementia Risk in Humans

Background: It has been estimated that one third of dementia cases may be preventable through modifiable lifestyle interventions. Epidemiological evidence suggests a link between stressful life events and aging-related cognitive decline and dementia; however, inherent methodological limitations in examining subjective and biological measures of stress separately leads to interpretive constraints. Objective: The aim of the current study was to conduct a systematic review of the research literature investigating the effect of perceived and biological measures of stress on dementia risk. Methods: A systematic review was conducted of cohort, case-control, longitudinal prospective or retrospective studies examining the association between stress and risk of developing dementia. Studies were identified from a systematic search across major electronic databases from inception to February 2020. Results: Overall, 22 studies were identified including a total of 496,556 participants, approximately 50% were females, with sample sizes ranging from 62–270,977. There was considerable heterogeneity in the definition and measurement of stress. Most of the identified studies reported a significant positive association between stress and dementia risk. Conclusion: Evidenced from the current review is that personality traits linked to increased perceived stress and elevated reported perceived stress, are associated with greater statistical risk for dementia. However, this review highlights that caution must be exhibited in interpreting these findings, as methodological issues with confounding adjustment may mediate these results. Future research should focus on the investigation of stress on dementia risk with a full range of confounding adjustment, and on biological measures of stress.

[Psychosocial stress, high blood pressure and cardiovascular risk]

Psychosocial stress can be the result of a wide variety of causes and circumstances. The experience of stress is often unique and experienced in a very personal way, although with common physiological responses. Predictably, it will increase in the modern world, which is subject to vertiginous social, cultural and technological changes. This review aims to determine the psychosocial factors that affect arterial hypertension (HT) and cardiovascular risk (CVR). Psychosocial stress more than doubles the risk of HT, the most related factors being post-traumatic stress disorder, anxiety and work stress. The factors that were most related to an increase in CVR were informal care, lower socioeconomic status, severe mental disorders, marital status, and post-traumatic stress disorder. Individual and collective psychosocial stress prevention strategies can be decisive in decreasing the prevalence of HT and CVR.

Social Adversity, Sleep Characteristics, and Elevated Blood Pressure Among Young Adult Black Females

Purpose: We examined whether sleep characteristics and adverse social exposures were associated with elevated blood pressure (BP) in young adult black women.

Methods: This is a cross-sectional analysis of existing data from 581 black females who participated in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Adverse social exposures included child abuse, discrimination, perceived stress, social isolation, and subjective social status. Self-reported sleep characteristics were measures of duration, latency, continuity, and snoring. Logistic regression was used to evaluate the influence of social exposures and sleep characteristics on BP.

Results: Among the women (mean age=29.1 years), 32.4% had elevated BP (≥130 systolic or ≥80 diastolic). In adjusted analysis, poor sleep continuity (adjusted odds ratio [aOR]=1.70, 95% confidence interval [CI]=1.07–2.70) and discrimination (aOR=1.61, 95% CI=1.00–2.58) were associated with higher odds of elevated BP, while more social isolation (aOR=0.69, 95% CI=0.48–0.99) was associated with lower odds of elevated BP.

Conclusion: Poor sleep continuity and experiencing discrimination may represent key risk factors for hypertension in young black females. Unexpectedly, being more isolated was associated with lower BP. Future research should examine how to adapt current paradigms and measures of social connectedness, isolation, and stress to better elucidate the impact of these factors on the long-term health of young black females.