Abstract P179: Hypertension Awareness is Associated With Negative Psychosocial Outcomes in Africans Americans in the Jackson Heart Study (JHS)
Authors: Butler Mark , Kalinowski Jolaade , Shimbo Daichi , Sims Mario , Booth John N , Bress Adam P , Tanner Rikki M , Jaeger Byron C , Fredericks Samuel , Ogedegbe Gbenga , Spruill Tanya M 
Published: March 2019

Introduction:
Although treating hypertension (HTN) reduces the risk of cardiovascular disease, being aware of a HTN diagnosis may have unintended consequences, including psychological distress and poorer perceived health. We hypothesized that African Americans meeting criteria for HTN, who are aware of a HTN diagnosis, would report higher levels of stress and depressive symptoms and poorer perceived health than those who are unaware.

Methods:
Our sample included 2,815 participants with HTN from the Jackson Heart Study, a community-based cohort of African Americans. HTN was defined as blood pressure ≥140/90 mm Hg or taking antihypertensive medication. Awareness of HTN was defined based on participants’ self-report of having been told by a health care provider that they had HTN or high blood pressure. Outcomes included depressive symptoms (Center for Epidemiologic Studies Depression score ≥16 vs. <16), chronic stress (Global Perceived Stress Scale, highest quartile vs. all others), weekly stress (Weekly Stress Inventory, highest quartile vs. all others) and self-rated health (poor or fair vs. good or excellent). Cross-sectional associations between HTN awareness and psychosocial outcomes were tested using multivariable Poisson regression with adjustment for age, sex, systolic blood pressure, diastolic blood pressure, antihypertensive medication, body mass index, comorbidities and health behaviors. Analyses were also stratified by recency of diagnosis (i.e., HTN diagnosed ≤3 vs. >3 years).

Results:
The majority of participants (2,572, 91.4%) were aware of having HTN while 243 (8.6%) were unaware. Among the aware participants, 15.5% were diagnosed ≤3 years ago and 84.5% were diagnosed >3 years ago. Aware participants were older (60.2 vs. 57.9, p=.002) and more likely to be female (68.4% vs. 47.7%, p<.001) than unaware participants. In fully adjusted models, HTN awareness was associated with higher levels of chronic stress (RR=1.55, 95% CI=1.09-2.22, p=0.016) and lower self-rated health (RR=1.55, 95% CI=1.05-2.29, p=0.028), and was marginally associated with higher weekly stress (RR=1.70, 95% CI=1.00-2.86, p=.053) and depressive symptoms (RR=1.60, 95% CI=0.95-2.70, p=.081). Overall, results did not differ based on recency of HTN diagnosis, except for a stronger association between awareness and weekly stress in the subgroup diagnosed >3 years ago.

Conclusions:
In a community-based sample of African Americans with HTN, participants who were aware of having a HTN diagnosis reported higher levels of stress and depressive symptoms and lower self-reported health compared to participants who were unaware. Prospective studies of the potential psychosocial consequences of diagnosing HTN are warranted, particularly in light of recent changes to BP treatment guidelines that result in an increased prevalence of HTN.