How does lower education get inside the body to raise blood pressure? What can we do to prevent this?

Abstract

It has long been known that lower socioeconomic status (SES) is a potent risk factor for cardiovascular disease.1 Much effort has been devoted to identifying the mechanisms responsible for this risk, because knowledge of these mechanisms is essential to guide the development of interventions to prevent or ameliorate the health-damaging effects. By showing that increased systolic blood pressure (SBP) levels in persons of lower educational attainment in a large sample drawn from the Paris metropolitan area are mediated to a significant extent by increased body mass index (BMI), waist circumference, and resting heart rate (HR), the report by Chaix et al2 in this issue of Hypertension makes an important contribution toward achieving this goal. Much work remains to be done, however, because the proportion of the association between lower individual education and elevated SBP explained by BMI/waist circumference and resting HR is 28.0% and 14.7%, respectively, meaning that a substantial proportion of the effect of lower education on SBP is mediated by other factors. Moreover, although it is helpful to know that one way lower education gets inside the body to raise blood pressure is via increased BMI, central fat accumulation, and resting HR, it is by no means clear how lower education gets inside the body to influence these mediators of increased blood pressure. Psychosocial risk factors like hostility, depression, and social isolation are increased in lower SES groups3,4 and, therefore, deserve attention …