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Psychosomatic Medicine 65:1012-1019 (2003)
© 2003 American Psychosomatic Society

ORIGINAL ARTICLES

Parental History of Hypertension and Coping Responses Predict Blood Pressure Changes in Black College Volunteers Undergoing a Speaking Task About Perceptions of Racism

Rodney Clark, PhD

Department of Psychology, Wayne State University, Detroit, MI.

Address correspondence to Rodney Clark, PhD, Biobehavioral Research Laboratory, Department of Psychology, Wayne State University, 71 West Warren, Detroit, MI 48202. E-mail: rclark{at}sun.science.wayne.edu


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGMENTS
 REFERENCES
 
OBJECTIVE: This investigation explored the relationship of coping responses and parental history of hypertension to task-induced blood pressure changes.

MATERIALS AND METHODS: The sample consisted of 215 black college student volunteers (median age = 25.95 y). During the speaking task, participants responded to standardized questions about perceptions of intra-ethnic and inter-ethnic group racism. Systolic blood pressure and diastolic blood pressure were measured via an automated blood pressure monitor. Usual ways of coping with intra-ethnic group racism were assessed with the COPE Scale, and parental history of hypertension (PHH) was self-reported by participants.

RESULTS: Findings from the final step of hierarchical general linear models indicated that the main effect of emotion-focused coping was negatively associated with diastolic blood pressure (p = 0.02) and systolic blood pressure (p = 0.002) changes. Further, these analyses revealed that PHH interacted: (1) with the coping responses of planning (p = 0.007) and denial (p = 0.002) to predict changes in systolic blood pressure and (2) with the planning coping response to predict diastolic blood pressure changes (p = 0.02). The direction of these effects indicated that among participants who were high in these coping responses, participants who also had a positive PHH had larger blood pressure changes. Regression analyses also revealed that PHH interacted with the cognitive coping response (p = 0.01) to predict changes in systolic blood pressure. The direction of this effect indicated that among participants who were low in this coping response, participants who also had a positive PHH had larger systolic blood pressure changes.

CONCLUSION: This study highlights the importance of examining the joint contribution of biological and psychosocial parameters to blood pressure reactivity in blacks.

Key Words: parental history of hypertension, • coping, • reactivity, • racism, • blacks.

Abbreviations: M = mean;; SD = standard deviation;; mm Hg = millimeters of mercury;; kg/m = kilograms/meter;; PHH = parental history of hypertension;; PLN = planning;; COG = cognitive;; DNL = denial.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGMENTS
 REFERENCES
 
Research indicates that blacks in the United States have disproportionately higher rates of primary hypertension (hypertension) than other ethnic groups (1). This notwithstanding, relatively few hypotheses have been forwarded to help explain the contribution of biological and psychosocial parameters to hypertension risk among blacks. One exception is the proposition that intra-ethnic group (intragroup) differences in blood pressure reactivity (reactivity) may account for blood pressure variability among blacks (2). Although research exploring the usefulness of reactivity as a predictor of resting blood pressure and incident hypertension has produced some results indicating that reactivity is not predictive of blood pressure status and is not stable over time (3,4), other studies have shown that reactivity is associated with future blood pressure status and clinical cardiovascular events (5–11), relatively stable (12–18), and related to stressful life events and/or perceptions of racism (19–22).

Consistent with previous research (2,21–25), perceptions of environmental stimuli as racist and as involving harm, a threat, or a challenge are hypothesized to be associated with psychological and physiological stress responses—the duration and magnitude of which is influenced by biological and psychosocial factors. Parental history of hypertension is one biological factor that is posited to influence reactivity (26). For example, reviews by Pickering and Gerin (4) and Matthews and Rakacsky (27) suggest that a positive parental history of hypertension is associated with exaggerated blood pressure responses to laboratory tasks. Among normotensives with a positive parental history of hypertension, an alteration in peripheral vascular capacity is one explanation of these exaggerated pressor responses (28). However, because the laboratory tasks in the majority of the studies reviewed by Pickering and Gerin were not entirely related only to behavior (eg, cold pressor), the role of behavioral factors alone could not be ascertained (4). Whereas some research using behavioral tasks (adult samples) support the findings from these reviews (29–31), other studies have failed to find a relationship between parental history of hypertension and reactivity (32–34). To the extent that reactivity is also influenced by psychosocial factors (35,36), the nil findings in these studies may be secondary to the relative failure to explore the contribution of such psychosocial factors as coping behaviors and resources (coping responses).

Coping responses are among the psychosocial factors that have been posited to influence reactivity and to mitigate psychological and physiological responses to environmental stimuli (2,26,33,37). For example, whereas some studies have shown that reactivity and resting blood pressure are positively associated with emotion-focused, avoidance, and cognitive coping responses (38–44), other studies have found inverse relationships between avoidance coping responses and reactivity (41,45). Still other research indicates that the relationship of emotion-focused coping (social support) to reactivity varies as a function of environmental stress (perceived racism) (46). With respect to problem-focused responses, significant findings have been more limited. While some investigations have showed that problem-focused responses are related to less marked reactivity and to lower resting blood pressure levels (40,41), other research has revealed that problem-focused coping responses are positively associated with reactivity (41).

Taken together, the aforementioned studies suggest that parental history of hypertension and coping responses to chronic stressors are biological and psychosocial factors, respectively, that may predate the development of hypertension via influencing acute elevations in pressor responses, which over time are posited to lead to blood pressure irregularities (eg, hyperreactivity, structural changes in the vasculature, and baroreceptor alterations) (21,23,28,35,37). If understanding the role of interactions between environmental exposures and individual response predispositions is among the considerations crucial for a causal model of stress reactivity (47), investigations exploring the extent to which biological and psychosocial factors interact to predict reactivity in blacks are warranted. Toward this end, the current investigation contributes to the existing literature in at least three ways. First, the sample size in the current study provides sufficient power to insure that the association between parental history of hypertension and reactivity in blacks could be explored with confidence. Second, because a mixture of coping responses is used to negotiate stressors (20,41,48–50), the contribution of different coping responses is examined concurrently. Third, this study is perhaps the first to explore the interactive effects of coping responses and parental history of hypertension to reactivity in a sample of blacks. The research questions for this exploratory investigation are as follows: (1) are coping responses and parental history of hypertension independent predictors of reactivity; and (2) do parental history of hypertension and coping responses interact to predict reactivity?


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 ACKNOWLEDGMENTS
 REFERENCES
 
Participants
Out of an eligible pool of 256 black college-student volunteers who participated in a larger investigation exploring biobehavioral predictors of pressor responses in blacks, 232 participants (91%) reported at least one experience of intragroup racism during their lifetime. Participants enrolled in the study were required to have self-reported experiences with either intragroup or intergroup racism. Of the 232 participants who reported at least one experience of intragroup racism, 93% (N = 215) completed the information needed to determine participant-reported parental history of hypertension (parental history of hypertension) and the necessary protocols for inclusion in this study. As a result, 41 student volunteers from the larger investigation were not eligible (nonparticipants). The final sample was 54.36% female, and the age range for participants was 17 to 56 years (median = 25.95 y, standard deviation [SD] = 8.60). The marital status of participants included 83.73% who were never married, 13.40% who were married, and 2.87% who were separated or divorced. With a mean body mass index of 27.15 kg/m2 (SD = 6.66), the mean baseline systolic blood pressure (117.69 mm Hg, SD = 15.56) and diastolic blood pressure (64.32 mm Hg, SD = 11.49) levels were within normal limits. On average, participants consumed 1.16 alcohol (SD = 2.16) and 2.23 caffeine (SD = 3.63) drinks per week and smoked 0.92 cigarettes per day (SD = 2.75). Approximately 8% of the sample used recreational drugs (N = 16), and 15.35% of the females used birth control medication (N = 33). The mean household income was in the range $25,000 to $29,999.

With exceptions of greater weekly alcohol consumption among participants (median = 1.16, SD = 2.16) compared with nonparticipants (median = 0.41, SD = 1.05), t = -3.38 (117), p = 0.001, and greater weekly caffeine consumption among participants (median = 2.23, SD = 3.63) compared with nonparticipants (median = 0.93, SD = 2.07), t = -3.19 (95), p = 0.002, t-test analyses did not reveal significant differences for participants and nonparticipants with respect to age, body mass index, baseline blood pressure, or cigarettes/day (p > 0.05). Further, chi-square analyses indicated that participant versus nonparticipant status was not significantly related to gender composition, marital status, or household income (p> 0.05). Valid chi-square analyses could not be computed for recreational drug use or birth control medication use, given the small cell sizes.

Participants for this convenience sample were recruited through university-wide advertisements and through established contacts with student organizations. By self-report, all participants were free of serious psychological (eg, major depression) and medical (eg, cerebrovascular disease) conditions and were offered research credit or a monetary incentive of $15.00 for their voluntary participation. Although compliance was not confirmed via an objective laboratory assessment, participants were instructed to refrain from consuming coffee, tea, and cola 12 hours before the laboratory session and to refrain from smoking 2 hours before the laboratory session.

Questionnaires and Task
Demographic
For the purpose of the current investigation, a demographic questionnaire was assembled to gather information about age, household income, parental history of hypertension, caffeine and alcohol intake, cigarette and recreational drug use, and use of birth control medication. One hundred thirty-eight participants reported that both parents had a negative history of hypertension; 62 reported that only one parent had a positive history of hypertension and the other parent had a negative history of hypertension; and 15 reported that both parents had a positive history of hypertension. Participant reports of parental history of hypertension were not verified by parental or physician reports.

Perceived racism
Because the speech task selected for this study addressed perceptions of both interethnic and intra-ethnic group racism, a 128-item Racism and Life Experiences Scale (51–53) was used to exclude participants who reported no perceptions of intra-ethnic group racism. The response scale ranged from 0 (none) to 4 (between 76% and 100% of the time). A composite score was derived by summing responses to lifetime perceptions of intra-ethnic group racism across nine domains (employment, law, finances, education, community, family/social relationships, emotional well-being, physical health, and public assistance). This composite had an alpha coefficient of 0.88, and was unrelated to self-deceptive enhancement (p > 0.11) (54).

Coping
The COPE scale (55) was used to measure usual ways of coping with intragroup racism. Because of low alpha coefficients (< 0.60), the active, suppressing competing activities, mental disengagement, and behavioral disengagement subscales were not used in the creation of the coping composites conceptualized by the scale authors. As such, the problem-focused composite included the planning subscale (total items = 4; {alpha} = 0.76); the emotion-focused composite included the seeking social support for emotional reasons, seeking social support for instrumental reasons, and focusing on venting emotions subscales (total items = 12; {alpha} = 0.74); the avoidance composite included the denial subscale (total items = 4; {alpha} = 0.65); and the cognitive composite included the accepting it, rest, and positive reinterpretation subscales (total items = 12; {alpha} = 0.74). Using a Likert scale, the responses for each scale item ranged from 1 (I usually do this 0%–25% of the time) to 4 (I usually do this 76%–100% of the time).

Vignette
A speaking task was used to elicit blood pressure responses. The vignette asked participants to speak about their views and feelings concerning ethnicity, skin tone, and about racism perpetuated by blacks and nonblacks. Other than the experimenter who observed and listened to the participant’s speech in an adjacent room equipped with a two-way mirror and voice listening device, an audience was not present. A variation of this vignette has been used in other research to elicit physiological responses (41).

Apparatus
A SunTech 4240 (SunTech, Raleigh, NC) portable blood pressure monitor was used to assess resting blood pressure and blood pressure reactivity. Using this noninvasive device, measurements were taken from the upper portion of the participant’s nondominant arm. The Suntech 4240 has been shown to be a valid measure of blood pressure and to measure resting blood pressure and reactivity reliably (56,57).

Procedure
Informed consent was obtained from each participant after the questionnaire packet was reviewed for completeness and questions about the study were answered. After being instructed to sit quietly for 5 minutes, baseline blood pressure assessments were taken every other minute during the last 5 minutes of the 10-minute baseline period. These readings were taken 5 minutes, 7 minutes, and 9 minutes into the baseline period (total readings = 3). After baseline, one of two black female experimenters returned to the room in which the participant was seated, handed the participant a clipboard with a stimulus sheet, and read standardized task instructions to all participants. The instructions were read as follows: "When I say begin, be prepared to address the five points listed on the sheet before you. When instructed to begin, you will have 3 minutes to deliver your speech. It is very important that the delivery of your speech is 3 minutes. Once your time has elapsed, you will be signaled to stop. Please read the sheet on the clipboard and begin your speech." The five points on which each participant was instructed to speak were as follows: (1) overall, how important has your skin color and ethnicity been to you; (2) how has your skin color affected the way that you are treated by other African Americans or blacks (for example, friends and family members, co-workers, teachers, school mates, at church, getting into clubs/organizations, getting a home, police officers, etc.); (3) how has your ethnicity affected the way that you are treated by people who are not African American or black (eg, whites) (for example, friends and family members, co-workers, teachers, school mates, at church, getting into clubs/organizations, getting a home, police officers, etc.); (4) describe your worst personal experience in the United States with intragroup racism (that is, racism perpetuated by other African Americans or blacks) directed at you. How did this incident make you feel as a person?; and (5) describe your worst personal experience in the United States with intergroup racism (that is, racism perpetuated by people who are not African American or black) directed at you. How did this incident make you feel as a person? The experimenter initiated the first reading when the participant started to speak. Throughout this task period, blood pressure readings were measured at 1-minute intervals. These readings were taken 30 seconds, 1.5 minutes, and 2.5 minutes into the task period (total readings = 3).

Data Reduction and Analyses
Predictor variables
Parental history of hypertension (dummy coded as 0 for neither parent with a history of hypertension or 1 for either/both parents with a history of hypertension) as well as the raw scores for the planning subscale, denial subscale, emotion-focused composite, and cognitive composite (total number of predictors = 5) were the primary predictor variables in the general linear models. Multiplying the relevant parental history of hypertension (class variable) and coping scale scores (interval variable) created the parental history of hypertension by coping interaction terms.

Studies indicate that several variables may be related to resting blood pressure and reactivity (1,19,33,35,40,42,58,59). As such, the potential for mitigation by age (in years), body mass index (kg/m2), cigarettes per day (continuous), alcohol drinks per week (continuous), caffeine drinks per week (continuous), Anger-in and anger-out (interval; 60), self-deceptive enhancement and impression management (interval; 54), household income (interval scale), subjective stressfulness of task (continuous analog rating), task-induced cynicism (continuous analog rating), task-induced anxiety (continuous analog rating), and task-induced anger (continuous analog rating) was assessed by examining the correlation between these variables and the criterion variables. These analyses revealed that baseline diastolic blood pressure was significantly related to changes in diastolic blood pressure (r = -0.23, p = 0.0004) and baseline systolic blood pressure (r = -0.21, p = 0.002), task-induced cynicism (r = 0.17, p = 0.01), and task-induced anger (r = 0.12, p = 0.05) were significantly associated with changes in systolic blood pressure. The potential mitigating effects of gender (male = 1, female = 2), birth control medication use (yes = 1, no = 2), and recreational drug use (yes = 1, no = 2) to reactivity were assessed using t tests. These analyses indicated that gender, birth control medication use, and recreational drug use were not significantly associated with systolic or diastolic blood pressure changes (p > 0.19). Given the results of these correlation and t-test analyses, in the model predicting changes in systolic blood pressure, baseline systolic blood pressure, task-induced cynicism, and task-induced anger were entered as control variables. In the model predicting changes in diastolic blood pressure, baseline diastolic blood pressure was entered as a control variable. Because the same predictors were used to predict the two indices of blood pressure (eg, parental history of hypertension, planning, parental history of hypertension by planning predicting changes in systolic blood pressure and parental history of hypertension, planning, parental history of hypertension by planning predicting changes in diastolic blood pressure), a Bonferroni correction was used to minimize spurious comparison-wise findings. As such, p < 0.025 (ie, 0.05/2) was the criterion of statistical significance for the individual effects in each model.

Criterion variables
Throughout the 10-minute baseline period, systolic blood pressure and diastolic blood pressure measurements taken at 5, 7, and 9 minutes were averaged to obtain baseline levels. During the 3-minute task period, systolic blood pressure and diastolic blood pressure assessments taken at 0.5, 1.5, and 2.5 minutes were averaged to obtain reactivity levels. Change scores (task level minus baseline level) were then calculated and used as the criterion variables in the regression analyses.

Analyses
The Statistical Analysis System (61) was used to compute all statistics. To examine the relationship of parental history of hypertension and coping responses to reactivity, two hierarchical general linear models were used. In each model, the control variables were entered in step 1; parental history of hypertension was entered in step 2; the four coping variables (planning, denial, emotion-focused composite, and cognitive composite) were entered in step 3; and the four parental history of hypertension by coping interaction terms were entered in step 4. In the first model, the change score for systolic blood pressure was used as the criterion variable, and in the second model, the change score for diastolic blood pressure was used as the criterion variable.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
DISCUSSION
 ACKNOWLEDGMENTS
 REFERENCES
 
Changes in Systolic Blood Pressure
In step 1, the three control variables (baseline systolic blood pressure, task-induced cynicism, and task-induced anger) accounted for 6.9% of variability in systolic blood pressure changes. The inclusion of the parental history of hypertension variable in step 2, accounted for 1.8% of variability in systolic blood pressure changes. In step 3, the entry of the coping variables accounted for 3.6% of unique variability in systolic blood pressure changes, and the interaction terms in the final step accounted for an additional 6.1% of variability in systolic blood pressure changes. The results from the final model, F(12,202) = 3.79, p < 0.0001, R2 = 0.18 are shown in Table 1. The direction of the parameter estimated associated with the significant emotion-focused coping effect indicated that as the use of this strategy increased, changes in systolic blood pressure decreased. Also shown in Table 1 and illustrated in Figures 1 and 2Go are the four parental history of hypertension by coping response interaction terms were significant (p < 0.025). Although the findings with respect to denial and planning indicated that parental history of hypertension was not significantly related to systolic blood pressure changes among participants low in these coping responses; among participants high in these coping responses, participants with a positive parental history of hypertension had larger changes in systolic blood pressure. An examination of the independent effects associated with the parental history of hypertension by cognitive term revealed that larger changes in systolic blood pressure were observed among participants who were both low in cognitive coping responses and who had a positive parental history of hypertension, relative to participants who were low in cognitive coping responses and who had a negative parental history of hypertension. Parental history of hypertension was not statistically related to systolic blood pressure changes among participants high in cognitive coping.


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  		TABLE 1. General Linear Models Predicting Changes in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)
 


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  		Figure 1. Mean changes in systolic blood pressure as a function of parental history of hypertension (PHH) and coping responses (denial = DNL, cognitive = COG, and planning = PLN). High/low PHH and coping response groups were created via median splits.

 


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  		Figure 2. Mean changes in diastolic blood pressure as a function of parental history of hypertension (PHH) and coping responses (planning = PLN). High/low PHH and PLN groups were created via median splits.

 
Changes in Diastolic Blood Pressure
A separate hierarchical general linear model was used to examine the relationship of parental history of hypertension and coping responses to diastolic blood pressure changes. The control variable (baseline diastolic blood pressure) accounted for 5.4% of variability in diastolic blood pressure changes in step 1, and the inclusion of the parental history of hypertension variable in step 2 accounted for an additional 1.1% of variability. The addition of the coping variables in step 3 accounted for 3.12% of unique variability in diastolic blood pressure changes, with the emotion-focused composite emerging as the only significant predictor (p = 0.013). In step 4 of the model, the parental history of hypertension by coping response variables were added and accounted for 3.5% of unique variability in diastolic blood pressure changes. The omnibus F-statistic associated with this final step was significant, F(10,204) = 3.09, p = 0.001, and the overall R2 was 0.13. Also shown in Table 1, this step indicated that the emotion-focused coping composite was significantly associated with changes in diastolic blood pressure. The direction of the parameter estimate indicated that as the use of these responses increased, diastolic blood pressure changes decreased. The findings from this final step also revealed that the parental history of hypertension by planning interaction term was significant. Illustrated in Figure 2, planning was not associated with diastolic blood pressure changes among participants low in this coping response but was positively associated with changes in diastolic blood pressure changes among participants high in this coping response.


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
ACKNOWLEDGMENTS
 REFERENCES
 
In a sample of black college-student volunteers, this study explored the association of parental history of hypertension and coping responses to reactivity. As shown in some (32–34) but not all (4, 29–31) studies, parental history of hypertension was not significantly related to reactivity. These nil findings should not be interpreted to mean that blacks are immune to the biological substrates that are hypothesized to be related to parental history of hypertension. Rather, from a stress-diathesis perspective (62), it is probable that blacks with a positive parental history of hypertension are at increased risk for peripheral vascular capacity alterations, for example, only when this individual response predisposition is present among individuals who are chronically exposed to environmental stressors such as racism.

Although the observation in the present sample that emotion-focused coping was negatively related to reactivity is consonant with the results of Hahn et al. (39), it is inconsistent with research indicating that these coping responses are positively related to blood pressure changes (41). The mixed findings in the literature with respect to emotion-focused coping may be attributable to differences in the conceptualization of emotion-focused coping. For example, in the present study the emotion-focused coping composite included two social support subscales, which research indicates is inversely related to reactivity and ambulatory blood pressure (42,63–65). Other studies, however, have not conceptualized social support as being an emotion-focused response (43,66). Irrespective of how emotion-focused coping is conceptualized, the results from this study indicated that the emotion-focused coping composite was the only coping response directly related to reactivity. It is probable that blacks perceive intragroup racism as being relatively uncontrollable. It is under conditions of appraised uncontrollability, according to the goodness-of-fit hypothesis (67), that emotion-focused coping, as observed in the current study, would be inversely related to stress responses. To the extent that emotion-focused coping (conceptualized as involving social support) is among the coping responses used more often by successful black college students (68) and is more "adaptive" when negotiating stressful environments in blacks (66), it is also probable that the failure to observe significant main effects for the other types of coping responses (ie, problem-focused, cognitive, and avoidant) is secondary to the observation that the efficacy of these responses are associated with and are more sensitive to factors such as appraised control (69–72). Taken together, in addition to documenting the frequency of coping responses used to negotiate environmental exposures, data regarding the self-reported efficacy of these responses, the differential use of these responses as a function of stressor controllability, and the relationship of efficacy and controllability to reactivity are needed.

Given the growing acknowledgment in the health psychology, behavioral medicine, and psychosomatic literature regarding the complexity of the biopsychosocial processes that underlie physiological functioning (24,47,73,74), perhaps the most important finding in the current investigation, was the significant interaction effects. The results revealed that the coping response of planning interacted with parental history of hypertension to predict both indices of blood pressure (ie, systolic and diastolic). Further, in three out of four significant interaction effects, the biological "burden" associated with parental history of hypertension was only apparent (via high reactivity) when these coping responses were high—with the one exception to this pattern, greater blood pressure changes were only apparent among participants who had a positive parental history of hypertension. To the extent that the use of coping responses is positively related to perceived stress and a positive parental history of hypertension increases biological risk, the interaction effects observed in this study lend additional support to the previously noted stress-diathesis perspective (62). That is, the use of coping responses that are associated with high psychological and physiological stress responses, when used chronically, has the potential of accelerating the physiological changes that are posited to be related to a biological predisposition toward blood pressure irregularities (28). Research that further explores the proposition that individual response predispositions (eg, parental history of subclinical and clinical cardiovascular events) are associated with physiological vulnerabilities whose expression (eg, hyperreactivity, structural changes in the vasculature, ventricular mass, and baroreceptor alterations) varies as a function of psychosocial factors such as coping responses is needed for at least two reasons. First, it may be possible to identify blacks in higher risk (eg, positive parental history of hypertension) and lower risk (eg, negative parental history of hypertension) groups who are more prone to blood pressure irregularities. Second, if reactivity is related to future blood pressure status (5–7,9), and if coping responses mitigate this relationship (2,27,67,75), then a more informed understanding of plausible biological and psychosocial mechanisms might be evinced.

As with most studies, the findings herein should be interpreted in light of certain methodological caveats. First, although the mean age of the sample in this study is higher than the mean age observed for more traditional college samples—a byproduct of the nontraditional student population that is characteristic of the urban university from whence the sample volunteered, the findings may not generalize to other age cohorts and socioeconomic groups. Regarding external validity, because the predictor variables included coping responses used to negotiate perceptions of intragroup racism, conclusions regarding the applicability of these findings to other problem categories (eg, nonethnically-relevant stressors) would be premature. Second, the use of coping composites—as opposed to individual coping responses, could be viewed as a disadvantage, in that the former may mix "adaptive" and "maladaptive" coping responses (76). It should be noted that the planning and denial coping variables were not composites in this study. They were the only subscales comprising the composites that were used in the analyses, given the low alpha reliabilities of the other subscales that were conceptualized by the scale authors to belong to the composite. The a priori decision to use composites in this study was secondary to observations that the use of coping composites has the potential advantage of facilitating comparisons with other studies that use composite indices and avoiding the production of large lists of individual coping responses that appear to lack conceptual cohesiveness (76). Third, the temporal relationship between the predictor variables could not be determined, given the nonexperimental study design. Fourth, although research indicates that the agreement between university students and parents’ report of parental history of hypertension is greater than 90% (32), future studies using parental or physician reports of hypertension would help to minimize a potential reporting bias. Fifth, while attempts were made to reduce the probability of spurious findings by using a more conservative alpha value, the parental history of hypertension by coping response interaction terms were not corrected for multiple comparisons. Sixth, task-induced changes in blood pressure were rather modest. Moreover, the amount of unique variability in systolic and diastolic blood pressure changes accounted for by the various coping styles was approximately two- to three-times the amount of variability accounted for by parental history of hypertension, the total amount of variability accounted for in the models predicting blood pressure changes was relatively small. As such, additional research is needed that delineates other factors that are associated with reactivity to similar laboratory challenges. The aforementioned caveats notwithstanding, this exploratory study highlights the importance of examining the joint contribution of biological and psychosocial parameters to blood pressure reactivity in blacks.


   ACKNOWLEDGMENTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGMENTS
REFERENCES
 
Preparation of this manuscript was supported by grants (MH56868 and MH01867) to the author from the National Institute of Mental Health. The author is grateful to Karen Freeman, Keisha Beard, and the Biobehavioral Research Group for their assistance with data collection and entry. Parental history of hypertension and coping responses predict blood pressure changes to a perceived racism speaking task in black college volunteers.

Received for publication January 28, 2003.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGMENTS
 REFERENCES
 

  1. National Center for Health Statistics. Health, United States, 1997. Maryland: Public Health Service, 1998.
  2. Clark R, Anderson N, Clark VR, et al. Racism as a stressor for African Americans: A biopsychosocial model. Am Psychol 1999; 54: 805–816.[CrossRef][Medline]
  3. Carroll D, Smith GD, Shipley MJ, et al. Blood pressure reactions to acute psychological stress and future blood pressure status: A 10-year follow-up of men in the Whitehall II study. Psychosom Med 2001; 63: 737–743.[Abstract/Free Full Text]
  4. Pickering TG, Gerin W. Cardiovascular reactivity in the laboratory and the role of behavioral factors in hypertension: A critical review. Ann Behav Med 1990; 12: 3–16.
  5. Light KC, Dolan CA, Davis MR, et al. Cardiovascular responses to an active coping challenge as predictors of blood pressure patterns 10 to 15 years later. Psychosom Med 1992; 54: 217–230.[Abstract/Free Full Text]
  6. Murphy JK, Alpert BS, Walker SS. Ethnicity, pressor reactivity, and children’s blood pressure. Five years of observations. Hypertension 1992; 20: 327–332.[Abstract/Free Full Text]
  7. Matthews KA, Woodall KL, Allen MT. Cardiovascular reactivity to stress predicts future blood pressure status. Hypertension 1993; 22: 479–485.[Abstract/Free Full Text]
  8. Everson SA, Goldberg DE, Kaplan GA, et al. Anger expression and incident hypertension. Psychosom Med 1998; 60: 730–735.[Abstract/Free Full Text]
  9. Light KC, Girdler SS, Sherwood A, et al. High stress responsivity predicts later blood pressure only in combination with positive family history and high life stress. Hypertension 1999; 33: 1458–1464.[Abstract/Free Full Text]
  10. Menkes MS, Matthews KA, Krantz DS, et al. Cardiovascular reactivity to the cold pressor test as a predictor of hypertension. Hypertension 1989; 14: 524–530.[Abstract/Free Full Text]
  11. Treiber FA, Kamarck T, Schneiderman N, et al. Cardiovascular reactivity and development of preclinical and clinical disease states. Psychosom Med 2003; 65: 46–62.[Abstract/Free Full Text]
  12. Durel LA, Kus LA, Anderson NB, et al. Patterns of stability of cardiovascular responses to variations of the cold pressor test. Psychophysiology 1993; 30: 39–46.[Medline]
  13. Kamarck TW, Jennings JR, Stewart CJ, et al. Reliable responses to a cardiovascular reactivity protocol: A replication study in a biracial female sample. Psychophysiology 1993; 30: 627–634.[Medline]
  14. Manuck SB, Kasprowicz A, Monroe SB, et al. Psychophysiologic reactivity as a dimension of individual differences. In: Schneiderman N, Weiss SM, Kaufmann P, eds. Handbook of methods and measurements in cardiovascular behavioral medicine. New York: Plenum; 1989: 365–382.
  15. Sherwood A, Girdler SS, Bragdon EE, et al. Ten-year stability of cardiovascular responses to laboratory stressors. Psychophysiology 1997; 34: 185–191.[Medline]
  16. Sherwood A, Turner JR, Light KC, et al. Temporal stability of the hemodynamics of cardiovascular reactivity. Int J Psychophysiol 1990; 10: 95–98.[CrossRef][Medline]
  17. Rutledge T, Linden W, Paul D. The stability of cardiovascular reactivity: Effects of task-type and family history over a 3-yr interval. Int J Behav Med 2001; 8: 293–303.
  18. Kamarck TW, Lovallo WR. Cardiovascular reactivity to psychological challenge: Conceptual and measurement consideration. Psychosom Med 2003; 65: 9–21.[Abstract/Free Full Text]
  19. Pardine P, Napoli A. Physiological reactivity and recent life-stress experience. J Consult. Clin Psychol. 1983; 51: 467–469.
  20. Clark R. Perceptions of inter-ethnic group racism predict increased vascular reactivity to a laboratory challenge in college women. Ann Behav Med 2000; 22: 214–222.[Medline]
  21. Clark R. Significance of perceived racism: Toward understanding ethnic-group disparities in health, the later years. National Research Council, Panel on Race, Ethnicity and Health in Later Life. Racial and ethnic disparities in aging health. Washington, DC: National Academy Press; in press.
  22. Bowen-Reid TL, Harrell JP. Racist experiences and health outcomes: An examination of spirituality as a buffer. J Black Psychol 2002; 28: 18–36.[Abstract]
  23. Brondolo E, Rieppi R, Kelly KP, et al. Perceived racism and blood pressure: A review of the literature and conceptual and methodological critique. Ann Behav Med 2003; 25: 55–65.[CrossRef][Medline]
  24. Harrell JP, Hall S, Taliaferro J. Physiological responses to racism and discrimination: An assessment of the evidence. Am J Public Health 2003; 93: 243–248.[Abstract/Free Full Text]
  25. Harrell SP. A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. Am J Orthopsych 2000; 70: 42–57.
  26. Shapiro D, Goldstein IB, Jamner LD. Effects of anger/hostility, defensiveness, gender, and family history of hypertension on cardiovascular reactivity. Psychophysiology 1995; 32: 425–435.[Medline]
  27. Matthews KA, Rakacsky CJ. Familial aspects of the Type A behavior pattern and physiologic reactivity to stress. In: Schmidt TH, Dembroski TM, Blumchen G, eds. Biological and psychological factors in cardiovascular disease. Berlin: Springer-Verlag; 1986: 228–245.
  28. Muldoon MF, Terrell DF, Bunker CH, et al. Family history studies in hypertension. Review of the literature. Am J Hypertens 1993; 6: 76–88.[Medline]
  29. Ditto B. Parental history of essential hypertension, active coping, and cardiovascular reactivity. Psychophysiology 1986; 23: 62–70.[Medline]
  30. Frazer NL, Larkin KT, Goodie JL. Do behavioral responses mediate or moderate the relation between cardiovascular reactivity to stress and parental history of hypertension. Health Psychol 2002; 21: 244–253.[CrossRef][Medline]
  31. Semenchuk EM, Larkin KT. Behavioral and cardiovascular responses to interpersonal challenges among male offspring of essential hypertensives. Health Psychol 1993; 12: 416–419.[CrossRef][Medline]
  32. al’Absi M, Everson SA, Lovallo WR. Hypertension risk factors and cardiovascular reactivity to mental stress in young men. Int J Psychophysiol 1995; 20: 155–160.[CrossRef][Medline]
  33. Lawler KA, Kline K, Seabrook E, et al. Family history of hypertension: A psychophysiological analysis. Int J Psychophysiol 1998; 28: 207–222.[CrossRef][Medline]
  34. Terrell DF, Manuck SB. Interactive influences of ethnicity, gender and parental history of hypertension on hemodynamic responses to behavioral challenge. Ethn Dis 1996; 6: 286–300.[Medline]
  35. Anderson NB, McNeilly M, Myers H. Autonomic reactivity and hypertension in Blacks: A review and proposed model. Ethn Dis 1991; 1: 154–170.[Medline]
  36. Herd JA. Cardiovascular responses to stress. Physiol Rev 1991; 71: 305–330.[Abstract/Free Full Text]
  37. Burchfield SR. The stress response: A new perspective. Psychosom Med 1979; 41: 661–672.[Abstract/Free Full Text]
  38. Clark VR, Harrell JP. The relationship among Type A behavior, styles used in coping with racism, and blood pressure. J Black Psychol 1982; 8: 89–99.[Abstract]
  39. Hahn WK, Brooks JOA, Hartsough Don M. Self-disclosure and coping styles in men with cardiovascular reactivity. Res Nurs Health 1993; 16: 275–282.[Medline]
  40. Krieger N, Sidney S. Racial discrimination and blood pressure: The CARDIA Study of young Black and White adults. Am J Public Health 1996; 86: 1370–1378.[Abstract/Free Full Text]
  41. Clark R, Anderson NB. Efficacy of racism-specific coping styles as predictors of cardiovascular functioning. Ethn Dis 2001; 11: 286–295.[Medline]
  42. Fontana A, McLaughlin M. Coping and appraisal of daily stressors predict heart rate and blood pressure levels in young women. Behav Med 1998; 24: 5–16.[Medline]
  43. Kohlmann CW, Weidner G, Messina CR. Avoidant coping style and verbal-cardiovascular response dissociation. Psychol Health 1996; 11: 371–384.
  44. Wright TA, Sweeney D. Coping strategies and diastolic blood pressure. Psychol Rep 1989; 65: 443–449.[Medline]
  45. Warrenburg S, Levine J, Schwartz GE, et al. Defensive coping and blood pressure reactivity in medical patients. J Behav Med 1989; 12: 407–424.[CrossRef][Medline]
  46. Clark R. Self-reported racism and social support predict blood pressure reactivity in Blacks. Ann Behav Med 2003; 25: 127–136.[CrossRef][Medline]
  47. Schwartz AR, Gerin W, Davidson KW, et al. Toward a causal model of cardiovascular responses to stress and the development of cardiovascular disease. Psychsom Med 2003; 65: 22–35.[Abstract/Free Full Text]
  48. Folkman S, Lazarus RS. If it changes it must be a process: Study of emotion and coping during three stages of a college examination. J Pers Soc Psychol 1985; 48: 150–170.[CrossRef][Medline]
  49. Plummer DL, Slane S. Patterns of coping in racially stressful situations. J Black Psychol. 1996; 22. 302–315.[Abstract]
  50. Utsey SO, Adams EP, Bolden M. Development and initial validation of the Africultural Coping Systems Inventory. J Black Psychol 2000; 26: 194–215.[Abstract/Free Full Text]
  51. Harrell SP. The Racism and Life Experiences Scales (RaLES). Unpublished instrument. California School of Professional Psychology, Los Angeles; 1997.
  52. Harrell SP. Development and initial validation of scales to measure racism-related stress. Poster presented at the 6th Biennial Conference on Community Research and Action, Society for Community Research and Action (Division 27-American Psychological Association), Columbia, SC; 1997.
  53. Harrell SP, Merchant MA, Young SA. Psychometric properties of the Racism and Life Experience Scales (RaLES). Paper presented at the Annual Convention of the American Psychological Association, Chicago, IL; 1997.
  54. Paulhus DL. BIDR reference manual for version 6. British Columbia: University of British Columbia; 1991.
  55. Carver DP, Scheier MF, Weintraub JK. Assessing coping strategies: A theoretically based approach. J Pers Soc Psychol 1989; 56: 267–283.[CrossRef][Medline]
  56. Mueller UK, Wells M, Radevski I, et al. Repeated automated versus daytime ambulatory blood pressure measurement in mild, moderate, and severe untreated black hypertensive patients. Blood Press Monit 1997; 2: 21–25.[Medline]
  57. Taylor RS, Gallen I. Evaluation of SunTech 4240 during rest and during exercise: A novel automated blood pressure device. J Cardiopulm Rehabil 1994; 14: 330.
  58. Armstead CA, Lawler KA, Gorden G, et al. Relationship of racial stressors to blood pressure responses and anger expression in Black college students. Health Psychol 1989; 8: 541–556.[CrossRef][Medline]
  59. Clark R, Adams J, Clark VR. Effects of John Henryism and anger-coping on mean arterial pressure changes in African American females. Int J Behav Med 2001; 8: 271–282.
  60. Speilberger CD. State-Trait anger expression inventory: Professional manual. Odessa, FL: Psychological Assessment Resources; 1996.
  61. SAS Institute, Inc. SAS System for Windows, Release 8.02. Cary, NC: SAS Institute 2001.
  62. Manuck SB, Kasprowicz AL, Muldoon MF. Behaviorally-evoked cardiovascular reactivity and hypertension: Conceptual issues and potential associations. Ann Behav Med 1990; 12: 17–29.
  63. Uchino BN, Kiecolt-Glaser JK, Cacioppo JT. Age-related changes in cardiovascular response as a function of a chronic stressor and social support. J Pers Soc Psychol 1992; 63: 839–846.[CrossRef][Medline]
  64. Karlin WA, Brondolo E, Schwartz J. Workplace social support and ambulatory cardiovascular activity in New York city traffic agents. Psychosom Med 2003; 65: 167–176.[Abstract/Free Full Text]
  65. Strogatz DS, Croft JB, James SA, et al. Social support, stress, and blood pressure in black adults. Epidemiology 1997; 8: 482–487.[CrossRef][Medline]
  66. McGee ZT, Davis BL, Brisbane T, et al. Urban stress and mental health among African-American youth: Assessing the link between exposure to violence, problem behavior, and coping strategies. J Cult Divers 2001; 8: 94–104.[Medline]
  67. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York, Springer; 1984.
  68. Kirkland ML. Stressors and coping strategies among successful female African American baccalaureate nursing students. J Nurs Educ 1998; 37: 5–12.[Medline]
  69. Anshel MH, Kaissidis AN. Coping style and situational appraisals as predictors of coping strategies following stressful events in sport as a function of gender and skill level. Br J Psychol 1997; 88: 263–276.
  70. Littrell J, Beck E. Predictors of depression in a sample of African American homeless men: Identifying effective coping strategies given varying levels of daily stressors. Community Ment Health J 2001; 37: 15–29.[CrossRef][Medline]
  71. Petrosky MJ, Birkimer JC. The relationship among locus of control, coping styles, and psychological symptom reporting. J Clin Psychol 1991; 47: 336–345.[Medline]
  72. Zakowski SG, Hall MH, Klein LC, et al. Appraised control, coping, and stress in a community sample: A test of the goodness-of-fit hypothesis. Ann Behav Med 2001; 23: 158–165.[CrossRef][Medline]
  73. Lovallo WR, Gerin W. Psychophysiological reactivity: Mechanisms and pathways to cardiovascular disease. Psychosom Med 2003; 65: 36–45.[Abstract/Free Full Text]
  74. Anderson NB. Levels of analysis in health science. A framework for integrating sociobehaivoral and biomedical research. Ann NY Acad Sci 1998; 840: 563–576.[Abstract/Free Full Text]
  75. Clark R. Subjective stress and coping resources interact to predict blood pressure reactivity in black college students. J Black Psychol. in press.
  76. Fields L, Prinz RJ. Coping and adjustment during childhood and adolescence. Clin Psychol Rev. 1997; 17: 937–976[CrossRef][Medline]



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