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Unfair Treatment and Trait Anger in Relation to Nighttime Ambulatory Blood Pressure in African American and White Adolescents

From the Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Danielle L. Beatty, Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213. E-mail: beattydl{at}upmc.edu

Objective: To determine if ambulatory blood pressure (ABP) at night relative to day ABP among adolescents is influenced by unfair treatment and trait anger, and whether these associations are stronger in African Americans and adolescents from lower socioeconomic status (SES) families and neighborhoods.

Methods: A total of 189 healthy white and African American adolescents (ages = 14–16 years, standard deviation = 0.62, 50% female) completed 2 days and 1 night of ABP monitoring and unfair treatment and trait anger questionnaires. SES was measured using 1) parental education and 2) a composite neighborhood SES score based on U.S. Census tract data for neighborhood poverty and education. The night/day ABP ratio was calculated by dividing the night ABP mean (readings from the self-reported bedtime of each participant through 5 AM) by the day ABP mean (8:30 AM until self-reported bedtime).

Results: Higher trait anger was associated with a higher night/day diastolic blood pressure (DBP) ratio in the full sample, B = 0.003, SE = 0.001, t = 2.20, p = .03. A significant interaction effect for Race x Unfair Treatment on the night/day DBP ratio, B = 0.01, SE = 0.003, t = 3.17, p = .002, followed by post hoc tests indicated that greater unfair treatment was associated with a higher night/day DBP ratio among African Americans, B = 0.006, SE = 0.002, t = 2.56, p = .01. Further, among African American adolescents living in lower SES neighborhoods, greater unfair treatment predicted a higher night/day DBP ratio, B = 0.008, SE = 0.003, t = 3.15, p = .002, and higher trait anger scores predicted a higher night/day DBP ratio, B = 0.008, SE = 0.002, t = 3.19, p = .002.

Conclusions: Trait anger may be a factor leading to elevated nighttime DBP in both African Americans and whites. Unfair treatment and trait anger are important predictors of elevated night/day ABP ratios among African American adolescents living in lower SES neighborhoods. These factors may contribute to the onset of hypertension in African Americans at a younger age.

Key Words: ambulatory blood pressure monitoring • unfair treatment • socioeconomic status • trait anger • hypertension

Abbreviations: ABP = ambulatory blood pressure; SBP = systolic blood pressure; DBP = diastolic blood pressure; CVD = cardiovascular disease; SES = socioeconomic status.