PSYCHOSOCIAL PREDICTORS OF HYPERTENSION IN BLACK-AND-WHITE AFRICANS

Objective: To test the hypothesis that psychosocial factors that are c losely related to the behavioural stress process in developing countri es have predictive value for the incidence of hypertension. Design: A cohort of 528 African students (220 White, 308 Black), mean+/-SD age 2 2+/-3.2 years, were followed up for 4 years at the University of Zimba bwe. Baseline measures of selected psychosocial variables such as anxi ety, anger, expression, active coping and family instability were made , together with biological and behavioural predictors of hypertension (initial blood pressure, heart rate, body mass, family history of hype rtension or diabetes, alcohol intake, smoking and number of years of u rbanization). Analyses were stratified by sex and ethnicity. Results: In multivariate analysis Black students had significantly greater base line anxiety levels and suppressed anger than White students, and Blac k students who went on to develop hypertension had significantly highe r baseline parameters than those who remained normotensive. In multiva riate regression analysis, including biological predictors, anxiety, s uppressed anger and family instability remained significant independen t predictors of hypertension in urbanized Black students. No psychosoc ial variable alone predicted hypertension in White students in multiva riate analyses. Conclusions: Among young, urbanized Black students, be sides the well-known genetic (family history of hypertension) and biol ogical (initial blood pressure, heart rate, body mass index, smoking a nd alcohol intake) predictors of hypertension, psychosocial factors ar e predictive of the later incidence of hypertension. Behavioural non-p harmacological treatment for hypertension might be considered in Afric an developing countries.