Daily interpersonal conflict predicts masked hypertension in an urban sample.
BACKGROUND
Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH.


METHODS
Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examine whether daily interpersonal conflict is an independent predictor of MMH.


RESULTS
This form of MMH (i.e., optimal office BP plus elevated ABP) was present in 21% of participants (n = 50). Those with MMH (vs. without) were significantly more likely to be men (P < 0.001). Daily harassment and unfair treatment scores were significant predictors of MMH group status (P < 0.05). Participants with harassment scores >30 were significantly more likely to be in the MMH group.


CONCLUSIONS
MH may be a concern, even for patients with optimal office BP. Evaluating exposure to psychosocial stressors, including routine levels of interpersonal conflict may help to identify those patients who might benefit from further clinical follow-up.
Schoenthaler
Antoinette M
AM
Department of Medicine, Center for Healthful Behavior Change, New York University School of Medicine, New York, USA.
Schwartz
Joseph
J
Cassells
Andrea
A
Tobin
Jonathan N
JN
Brondolo
Elizabeth
E
D000328:Adult; D044383:Black People; D001794:Blood Pressure / Q000502:physiology; D003220:Conflict, Psychological; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D007398:Interpersonal Relations; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D009519:New York City / Q000453:epidemiology; D012919:Social Behavior; D012923:Social Class; D012931:Social Environment; D012959:Socioeconomic Factors; D014505:Urban Population; D001741:Black or African American