Abstract
African Americans experience disproportionate stress over the life course, which has been posited as an explanatory mechanism underlying racial disparities in CVD risk. We studied associations between measures of self-reported psychosocial stress and allostatic load (AL) (elevated or fluctuating endocrine or neural responses resulting from chronic stress) among 74 participants of the Achieving Blood Pressure (BP) Control Together (ACT) study—a randomized control trial to improve BP self-management and control among African Americans. We examined ancillary AL biomarkers (i.e., DHEA-S, cortisol, CRP, IL-6) in addition to ACT study measures (i.e., HbA1c, diabetes status, total cholesterol, HDL-C, triglycerides, hyperlipidemia, urinary microalbumin) collected at 12-months follow-up. We used linear univariable and multivariable regression to estimate correlations between ratings of the Perceived Stress Scale (PSS-10), the Everyday Discrimination Scale, and the Patient Health Questionnaire (PHQ-8) with total AL score (1 point per aforementioned component measure threshold achieved) and its components. Ninety-three percent of the sample reported moderate to severe stress; the mean discrimination score was 14.9 (SD: 7.4) (of a possible 39 points); 22% had moderate to severe depressive symptoms. The mean AL score was 3 of a possible total of 11. Perceived stress was negatively associated with CRP adjusting for other components and patient characteristics. Discrimination was associated with increases in inflammatory factors; however, this association diminished after adjusting for other AL components and patient characteristics. Depressive symptoms were positively associated with inflammatory factors and triglycerides adjusting for other AL components and patient characteristics. In conclusion, the findings from this study of African Americans with hypertension suggest correlations between self-reported psychological stressors and AL components, but not total AL score.
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