Neighborhood stressors and race/ethnic differences in hypertension prevalence (the Multi-Ethnic Study of Atherosclerosis)

Am J Hypertens. 2011 Feb;24(2):187-93. doi: 10.1038/ajh.2010.200. Epub 2010 Sep 16.


Background: The reasons for racial/ethnic disparities in hypertension (HTN) prevalence in the United States are poorly understood.

Methods: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether individual- and neighborhood-level chronic stressors contribute to these disparities in cross-sectional analyses. The sample consisted of 2,679 MESA participants (45-84 years) residing in Baltimore, New York, and North Carolina. HTN was defined as systolic or diastolic blood pressure ≥140 or 90 mm Hg, or taking antihypertensive medications. Individual-level chronic stress was measured by self-reported chronic burden and perceived major and everyday discrimination. A measure of neighborhood (census tract) chronic stressors (i.e., physical disorder, violence) was developed using data from a telephone survey conducted with other residents of MESA neighborhoods. Binomial regression was used to estimate associations between HTN and race/ethnicity before and after adjustment for individual and neighborhood stressors.

Results: The prevalence of HTN was 59.5% in African Americans (AAs), 43.9% in Hispanics, and 42.0% in whites. Age- and sex-adjusted relative prevalences of HTN (compared to whites) were 1.30 (95% confidence interval (CI): 1.22-1.38) for AA and 1.16 (95% CI: 1.04-1.31) for Hispanics. Adjustment for neighborhood stressors reduced these to 1.17 (95% CI: 1.11-1.22) and 1.09 (95% CI: 1.00-1.18), respectively. Additional adjustment for individual-level stressors, acculturation, income, education, and other neighborhood features only slightly reduced these associations.

Conclusion: Neighborhood chronic stressors may contribute to race/ethnic differences in HTN prevalence in the United States.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use
  • Atherosclerosis / ethnology*
  • Atherosclerosis / physiopathology
  • Atherosclerosis / psychology
  • Blood Pressure
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Health Status Disparities*
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Hypertension / drug therapy
  • Hypertension / ethnology*
  • Hypertension / physiopathology
  • Hypertension / psychology
  • Logistic Models
  • Male
  • Middle Aged
  • Prejudice
  • Prevalence
  • Residence Characteristics / statistics & numerical data*
  • Risk Assessment
  • Risk Factors
  • Socioeconomic Factors
  • Stress, Psychological*
  • United States / epidemiology


  • Antihypertensive Agents