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Effect of Social Support on Nocturnal Blood Pressure Dipping

From the Department of Medicine (C.J.R., M.M.B., J.M., T.G.P., S.H., M.R.D.T.), Columbia University, New York, New York; Department of Neurology (R.L.S., B.B.-A.), Columbia University, New York, New York; Department of Epidemiology (C.J.R., R.L.S.), Columbia University, Mailman School of Public Health, New York, New York; Department of Sociomedical Science (B.B.-A.), Columbia University, Mailman School of Public Health, New York, New York; Department of Biostatistics (Z.J.), Columbia University, Mailman School of Public Health, New York, New York; Department of Neurology (R.L.S.), University of Miami, Miami, Florida; and Section of Cardiovascular Medicine (M.W.B.), Yale University, New Haven, Connecticut.

Address correspondence and reprint requests to Carlos J. Rodriguez, Division of Cardiology, Columbia University, 622 W 168th street; PH 3-342, New York, NY 10032. E-mail: cjr10{at}columbia.edu

Objective: To determine if nocturnal blood pressure (BP) dipping among non-Hispanic blacks is influenced by social support. Non-Hispanic blacks have higher rates of cardiovascular morbidity and mortality from hypertension and are more likely to have ambulatory blood pressure (ABP) that remains high at night (nondipping).

Methods: A total of 68 non-Hispanic black normotensive and 13 untreated hypertensive participants (age 72 ± 10 years, 48% female) free of clinical cardiovascular disease completed 24-hour ABP monitoring and a questionnaire that included a modified version of the CARDIA Study Social Support Scale (CSSS). Nondipping was defined as a decrease of <10% in the ratio between average awake and average asleep systolic BP. Analyses were adjusted for age, gender, and systolic BP.

Results: The prevalence of nondipping was 26.8% in subjects in the highest CSSS tertile versus 41.1% in the lowest CSSS tertile (p = .009). On adjusted analysis, CSSS was analyzed as a continuous variable and remained independently and inversely associated with nondipping (odds ratio 0.27, 95% Confidence Interval 0.08–0.94, p = .04).

Conclusions: Social support may be an important predictor of BP dipping at night. These findings suggest that social support may have positive health affects through physiologic (autonomic) pathways.

Key Words: ambulatory blood pressure monitoring • social support • African-Americans • hypertension

Abbreviations: BP = blood pressure; ABP = ambulatory blood pressure; NOMASS = Northern Manhattan Stroke Study; CSSS = CARDIA Social Support Scale; BMI = body mass index; OR = odds ratio; SD = standard deviation.

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