Caregiver stress may increase hypertension risk in Black women

A new analysis finds that the stress of being a caregiver is associated with an increased risk of developing high blood pressure in 21- to 44-year-old Black women, a group known to have a higher prevalence of the condition compared with women of other racial and ethnic groups.

Caregiving has been linked by past studies to high blood pressure, also known as hypertension, in middle-aged and older Black women, but this relationship has been understudied in this younger group.

Published online recently in the American Heart Association journal Hypertension, the new study shows that, with an average follow-up of 7.4 years, 43.5 percent of all participants developed hypertension. The research team, led by researchers at NYU Grossman Long Island School of Medicine, also found that 51.7 percent of study participants that reported having moderate or high caregiving stress developed hypertension, versus 40.6 percent of those with low caregiving stress or none.

Our analysis suggests that caregiver strain as a source of chronic stress may significantly contribute to the development of hypertension, a major risk factor for cardiovascular disease (CVD), among reproductive-age Black women.”

Milla Arabadjian, PhD, corresponding study author, assistant professor in the Department of Foundations of Medicine at NYU Grossman Long Island School of Medicine

Among younger Black women with hypertension, rates of uncontrolled blood pressure are high, and finding “addressable” risk factors (like caregiving stress) is important for tailoring prevention for this population.

The study finding was made even more relevant by an advisory issued recently by the United States surgeon general, Dr. Vivek Murthy, saying that parents and caregivers over the last decade have experienced much higher levels of stress and mental health issues than noncaregivers. Caregiving is a source of chronic stress that is particularly significant for women, because they make up the majority of informal caregivers, say the authors.

Study detail

The current study authors examined the links between caregiving stress, caregiving of high-needs dependents, and hypertension among reproductive-age women enrolled in the Jackson Heart Study (JHS). The new work is a secondary analysis of the JHS, one of the largest long-term (longitudinal) group studies focused on the cardiovascular health of Black adults. The JHS, which started collecting data in 2000, follows the health of more than 5,300 Black adults from three Mississippi counties, with follow-up still underway.

Caregiving stress was assessed through patient responses to a key question within the global perceived stress scale, a standard measure in which patients report on the stress affecting their lives. The caregiving stress question was “Over the past 12 months, how much stress did you experience related to caring for others?”

Responses were measured on a four-point scale, ranging from (1) not stressful to (4) very stressful. To simplify the results, the team split responses into two groups reporting either no/low caregiving stress or moderate/high caregiving stress. JHS defines hypertension as systolic blood pressure above 140 mm Hg (milliliters of mercury, standard measure), diastolic blood pressure above 90 mm Hg, or self-report of taking antihypertensive medication at follow-up exams.

“Given the high lifetime risk of CVD especially among reproductive-age Black women, we need to better identify the root causes contributing to the strain,” says senior study author Tanya M. Spruill, PhD, associate professor in the Departments of Population Health and Medicine at NYU Langone Health. “If a lack of affordable childcare is a source, then linkage to childcare resources could be one solution. If the source of strain is a communication challenge with a child or elderly relative, education might be tailored to help with that,” adds Dr. Spruill, who co-leads the Jackson Heart Study Hypertension Working Group, funding from which supported the current paper.

Another NYU Langone author was Yiwei Li, PhD, of the Division of Biostatistics in the Department of Population Health. Also making important contributions to the study were authors Calvin L. Colvin, MSPH, of the Mailman School of Public Health and Jacquelyn Y. Taylor, PhD, PNP-BC, RN, FAHA, FAAN, of the School of Nursing, both at Columbia University; Miriam A. Miles of Heersink School of Medicine and Paul Muntner, PhD, of the School of Public Health, both at the University of Alabama at Birmingham; Byron C. Jaeger, PhD, in the Department of Biostatistics and Data Science at Wake Forest School of Medicine; Jolaade Kalinowski, Ed.D, in the Department of Human Development and Family Sciences at the University of Connecticut; Lenette M. Jones, PhD, RN, FAHA, at the University of Michigan School of Nursing, and Kenneth R. Butler, PhD, of the University of Mississippi Medical Center.

The Jackson Heart Study is supported by grants from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities, both part of the National Institutes of Health. The JHS is conducted in collaboration with Jackson State University and through grant HHSN268201800013I. The current analysis was also supported by funding from the NHLBI grant R01HL117323.