BackgroundChronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community‐based cohort of blacks.Methods and ResultsAnalyses included 1829 participants without hypertension at baseline (Exam 1, 2000–2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005–2008) or Exam 3 (2009–2012). Each follow‐up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported “a lot” or “extreme” stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow‐up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age‐, sex‐, and time‐adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04–1.37) and 1.37 (1.20–1.57), respectively (P trend<0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001).ConclusionsIn a community‐based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk.

Recent studies have suggested that prediabetes is associated with an increased risk for cardiovascular disease (CVD) only among individuals with concomitant hypertension. RESEARCH DESIGN AND METHODS We analyzed the association between prediabetes and CVD by hypertension status among 3,313 black adults in the Jackson Heart Study (JHS) without diabetes or a history of CVD at baseline (2000-2004). Prediabetes was defined as fasting plasma glucose between 100 and 125 mg/dL or hemoglobin A 1c between 5.7 and 6.4% (39 and 46 mmol/mol). Hypertension was defined as systolic/diastolic blood pressure ‡140/90 mmHg and/or self-reported antihypertensive medication use. Participants were followed for incident CVD events and all-cause mortality through 31 December 2014. RESULTS Overall, 35% of JHS participants did not have prediabetes or hypertension, 18% had prediabetes alone, 22% had hypertension alone, and 25% had both prediabetes and hypertension. Compared with participants without either condition, the multivariableadjusted hazard ratios for CVD events among participants with prediabetes alone, hypertension alone, and both prediabetes and hypertension were 0.86 (95% CI 0.51, 1.45), 2.09 (1.39, 3.14), and 1.93 (1.28, 2.90), respectively. Among participants with and without hypertension, there was no association between prediabetes and an increased risk for CVD (0.78 [0.46, 1.34] and 0.94 [0.70, 1.26], respectively). No association was present between prediabetes and all-cause mortality among participants with or without hypertension. CONCLUSIONS Regardless of hypertension status, prediabetes was not associated with an increased risk for CVD or all-cause mortality in this cohort of black adults. Prediabetes is an intermediate glycemic state between normal glycemia and diabetes that is characterized by impaired fasting glucose (100-125 mg/dL), impaired glucose tolerance (2-h plasma glucose concentration 140-199 mg/dL after an oral glucose challenge), or a hemoglobin A 1c (HbA 1c) between 5.7 and 6.4% (39 and 46 mmol/mol) (1,2). Approximately 84.1 million U.S. adults $18 years of age had prediabetes in 2015 (3). A higher proportion of non-Hispanic blacks in the U.S. have prediabetes compared with non-Hispanic whites and Hispanics (1).

Heart disease remains the leading cause of death among women in the United States. Significant racial and gender disparities in cardiovascular disease (CVD) persist and high risk among young and middle-aged black women in particular is becoming increasingly apparent. Compared with white women, black women have more CVD risk factors, develop CVD earlier, and have higher CVD mortality rates 1. Further, despite overall declines in CVD mortality rates over the past several decades, black women 35 to 54 years of age are experiencing a concerning slowing of annual declines in mortality. 2

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Although mean blood pressure (BP) increases with age, there may be a subset of individuals whose BP does not increase with age. Characterizing the population that maintains normal BP could inform hypertension prevention efforts. We determined the proportion of Jackson Heart Study participants that maintained normal BP at 3 visits over a median of 8 years. Normal BP was defined as systolic BP <120 mm Hg and diastolic BP <80 mm Hg without antihypertensive medication. We identified lifestyle and psychosocial factors associated with maintaining normal BP and calculated the incidence rate for cardiovascular disease (CVD). Overall, 757 of 3432 participants (22.1%) had normal BP at baseline, and 262 of these participants (34.6%) maintained normal BP. Among participants with normal BP at baseline, normal body mass index (risk ratio [RR] 1.37 [95% CI, 1.08–1.75]), ideal physical activity (RR, 1.28 [95% CI, 0.99–1.65]), and never smoking (RR, 1.48 [95% CI, 0.99–2.20]) at baseline were associated with maintaining normal BP. Maintaining normal body mass index (RR, 1.42 [95% CI, 1.10–1.84]) and ideal physical activity (RR, 1.51 [95% CI, 1.18–1.94]) at all study visits were associated with maintaining normal BP. The cardiovascular disease incidence rate was 4.5, 6.3, and 16.4 per 1000 person-years among participants who maintained normal BP, had normal BP at baseline but did not maintain normal BP, and had elevated BP or hypertension at baseline, respectively, over 5.9 years of follow-up. These data suggest that maintaining normal body mass index and ideal physical activity are potential approaches for African American adults to maintain normal BP.