Socioeconomic status, psychosocial factors, race and nocturnal blood pressure dipping in a Hispanic cohort

Abstract

Background: Little information is available about the relationship of socioeconomic status (SES) to blunted nocturnal ambulatory blood pressure (ABP) dipping among Hispanics and whether this relationship differs by race. We sought to characterize ABP nondipping and its determinants in a sample of Hispanics.

Methods: We enrolled 180 Hispanic participants not on antihypertensive medications. SES was defined by years of educational attainment. All participants underwent 24-hour ABP monitoring. A decrease of <10% in the ratio between average awake and average asleep systolic BP was considered nondipping.

Results: The mean age of the cohort was 67.1 ± 8.7, mean educational level was 9.4 ± 4.4 years, and 58.9% of the cohort was female. The cohort was comprised of 78.3% Caribbean Hispanics with the rest from Mexico and Central/South America; 41.4% self-identified as white Hispanic, 34.4% self-identified as black Hispanic, and 24.4% did not racially self- identify. The percentage of nondippers was 57.8%. Educational attainment (10.5 years vs. 8.6 years; P <0.01) was significantly higher among dippers than nondippers. In multivariable analyses, each 1-year increase in education was associated with a 9% reduction in the likelihood of being a nondipper (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84-0.98; P = 0.01). There were significantly greater odds of being a nondipper for black Hispanics than for white Hispanics (OR, 2.83, 95% CI, 1.29-6.23; P = 0.005). Higher SES was significantly protective of nondipping in white Hispanics but not black Hispanics.

Conclusions: These results document a substantial prevalence of nondipping in a cohort of predominantly normotensive Hispanics. Dipping status varied significantly by race. Lower SES is significantly associated with nondipping status, and race potentially impacts on this relation.

Figure 1.

Proportion of participants according to ambulatory blood pressure nondipping status by race. The prevalence of nondipping depends on race. The proportion of white Hispanics was not different among dippers vs. nondippers; however, the proportion of black Hispanics more than doubles when going from dippers to nondippers.

Figure 2.

Differences in dipping status by race and education and race and income. (a) Prevalence of ambulatory blood pressure (ABP) nondipping was high among black Hispanics regardless of educational level, whereas among white Hispanics, ABP nondipping prevalence was high only among those with lower education. (b) Among participants with high income levels, being black Hispanic was associated with more prevalent ABP nondipping compared with white Hispanic. All Hispanics at low income levels regardless of race had a similar prevalence of ABP nondipping.