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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3143 — Investigating Changes in Stress, Body Mass Index, and Blood Pressure in Hypertensive Veterans During a 6-Month Period

McCloskey DMFriedberg JPLin I, and Kaplan E, VA NY Harbor Healthcare System; Lipsitz S, Harvard University; Natarajan S, VA NY Harbor Healthcare System;

Objectives:
Uncontrolled hypertension increases the risk for stroke and coronary artery disease. Stress and obesity are postulated to be important modifiers of hypertension effects; however, the relationship between them is still unclear. We evaluated if change in perceived stress level (PSL) or body mass index (BMI) is related to blood pressure (BP) lowering over a 6-month period.

Methods:
The study sample (N = 533) included Veterans with uncontrolled hypertension randomized into a clinical trial to improve hypertension control. Veterans were monitored for changes in BP between baseline and 6-month visits using the mean of 6 automated readings. Veterans’ PSL was measured at baseline and 6 months using the Perceived Stress Scale (range 0 – 40). Robust regression analysis was conducted on systolic (SBP) and diastolic (DBP) BP changes regressed on changes in PSL and BMI change while controlling for age, change in cardiovascular exercise and study arm.

Results:
At 6 months (n = 442), average changes in SBP and DBP were -4.29 and -2.84 mm Hg, respectively. Analyses showed that changes in PSL were not associated with changes in SBP or DBP in the study sample. However, a 1-point decrease in BMI over 6 months was associated with a 1.97 mm Hg decrease in SBP (p <0.01) and a 1.25 mm Hg decrease in DBP (p <0.01). Additional analysis showed there were no significant interactions between intervention arm and PSL. Following these results, it was hypothesized that high PSL may indirectly influence BP through BMI based on the stress-induced effects of cortisol. However, regression analyses showed that the relationship between changes in PSL and BMI was insignificant.

Implications:
In a sample of Veterans with hypertension, there were significant associations between changes in BP and changes in BMI over a 6-month period.

Impacts:
While Veterans’ PSL was not associated with lowered BP at 6 months, changes in BMI were correlated with observed reductions in BP. This suggests that a reduction in BMI due to improved diet and exercise habits may lower BP over a 6-month period. Accordingly, clinicians may find success in lowering patients’ risk of BP-related complications by assisting them in reducing BMI.


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