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Everyday Discrimination and Nocturnal Blood Pressure Dipping in Black and White Americans

From the University of California, San Diego; San Diego State University, and University of California, San Diego, Joint Doctoral Program in Clinical Psychology (L.T.), San Diego, California; and the Department of Psychiatry (D.C.C., P.J.M., R.A.N., J.E.D.), University of California, San Diego, San Diego, California.

Address correspondence and reprint requests to Lianne Tomfohr, Department of Psychology, University of California, San Diego, 9500 Gilman Drive, Mail Code 0804, La Jolla, CA 92093-0804. E-mail: ltomfohr{at}ucsd.edu

Objective: To investigate whether an association exists between experiences of everyday discrimination and blood pressure (BP) dipping in a biracial sample of black and white adults. Attenuated nocturnal BP dipping is closely linked to cardiovascular morbidity and mortality. Self-reported experiences of everyday discrimination have also been associated with negative cardiovascular health outcomes.

Methods: Seventy-eight hypertensive and normotensive women and men (n = 30 black and 48 white) reported on their experiences of everyday discrimination (Everyday Discrimination Scale) and underwent two separate 24-hour ambulatory BP monitoring (ABPM) sessions approximately 1 week apart.

Results: Correlation analysis revealed that higher endorsement of everyday discrimination was significantly associated with less diastolic BP (DBP) and systolic BP (SBP) dipping (p < .05). Subsequent hierarchical regression analyses indicated that everyday discrimination explained 8% to 11% of the variance in SBP and DBP dipping above and beyond other demographic and life-style-related factors, including race, age, 24-hour BP, body mass index, and current socioeconomic status. The relationship between discrimination and dipping was significantly stronger on the second night of monitoring. Finally, analyses revealed that everyday discrimination mediated the relationship between race and BP dipping.

Conclusions: These findings suggest that experiences of everyday discrimination are associated with less nocturnal SBP and DBP dipping above and beyond the effect of known covariates. The use of multiple ABPM sessions may facilitate the detection of relationships between psychological variables and BP dipping.

Abbreviations: BP = blood pressure; ABPM = ambulatory blood pressure monitoring; DBP = diastolic blood pressure; SBP = systolic blood pressure; BMI = body mass index; SES = socioeconomic status.