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From the Department of Psychiatry (C.J.S., R.A.N., D.D., J.E.D.), University of California, San Diego, San Diego, California; and the Health Services Research & Development Service (C.J.S.), Veteran Affairs San Diego Healthcare System, San Diego, California.
Address correspondence and reprint requests to Carl J. Stepnowsky, Jr, PhD, Health Services Research & Development Service (111N-1), Veteran Affairs, San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail: cstepnowsky{at}ucsd.edu
OBJECTIVE: With the advent of ambulatory blood pressure monitoring has come the awareness that blood pressure (BP) normally drops, or "dips," at night by roughly 10%. A number of pathological conditions have been associated with the nondipping of nocturnal BP. In general, researchers have looked at dipping in neurological and cardiovascular disorders. We examined the extent to which nocturnal nondipping might be influenced by relatively gross measures of social environment.
METHODS: This study examined 78 healthy adults and adults with mild hypertension who were not currently receiving medication, aged 25 to 52 years (mean age = 38.2). Forty-two participants self-identified as black and 36 identified as white.
RESULTS: Age, body mass index, apnea–hypopnea index, screening BP, ethnicity, and socioeconomic status (SES) were significantly associated with nocturnal BP dipping, accounting for 41% of the variance in dipping (F[6,51] = 5.473, p < .001). When SES was entered on the last step of a hierarchical regression analysis, it independently accounted for 8% of the variance in dipping, even after accounting for ethnicity, such that the lower the SES, the more the nondipping.
CONCLUSION: It remains to be seen what aspect of the social environment may be driving this association between nondipping and lower social class. However, investigators might consider including social class in their models in future studies.
Key Words: blood pressure, • ambulatory blood pressure monitoring, • dipping status, • ethnicity, • social class.
Abbreviations: SES = socioeconomic status;; BP = blood pressure;; MAP = mean arterial pressure;; OSA = obstructive sleep apnea;; AHI = apnea–hypopnea index;; BMI = body mass index.
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