Maya McNeilly

Effects of perceived racism and anger inhibition on ambulatory blood pressure in African Americans.

Objective Hypertension is more prevalent in African Americans compared with Americans of European descent. Preliminary evidence indicates that perceived racism may play a role in elevated blood pressure in African Americans. The present study examined whether perceived racism was associated with higher ambulatory blood pressure measured during daily life. A potential contributing role for anger inhibition was also evaluated. Methods Twenty-four–hour ABP was obtained from 69 African American men and women with normal or mildly elevated blood pressure. ABP was averaged over waking and sleep periods, and clinic BP was also assessed. Perceived racism and anger expression were measured using self-report questionnaires. Results Greater perceived racism was related to higher ABP during waking hours for SBP (p < .01) and DBP (p < .05). Perceived racism was positively correlated with anger inhibition (r = .29, p < .05) but was not related to outwardly expressed anger (r = .01, NS). Anger inhibition was related to higher sleep DBP (p = .05) and a smaller drop in DBP from day to night (p < .05). Anger inhibition did not account for the relationship between perceived racism and blood pressure. Conclusions Perceived racism and anger inhibition are independently related to higher ABP. Both may contribute to the incidence of hypertension and hypertensive-related diseases observed in African Americans.

Initial assessment of a new instrument to measure quality of life at the end of life.

PURPOSE We conducted this study to pilot a new multidimensional instrument to assess the quality of life at the end of life. METHODS Items were derived from focus groups and a national survey identifying attributes of the quality of dying. Fifty-four items measured on a five-point Likert scale covered six domains. We administered the instrument to equal numbers of Veterans Administration (VA) and university medical center outpatients with advanced serious illness. We assessed psychometric properties using factor analysis. RESULTS Two hundred patients completed the instrument (response rate, 85%). Diagnoses included cancer (64%), congenital heart failure (CHF) (19.5%), end-stage renal disease (ESRD) (10%) and chronic obstructive pulmonary disease (COPD) (6.5%). Seventy-four percent were male, 64% were caucasian, and 34% African American. Item reduction and factor analysis yielded a final instrument with 24 items in 5 distinct domains (overall Cronbach a = 0.83). The first factor (6 items; a = 0.84) measured a sense of completion, particularly through contributions to others. The second factor (7 items; alpha = 0.77) measured relations with the health care system. The third factor (6 items; alpha = 0.77) measured preparation. The fourth factor (4 items; alpha = 0.77) measured symptom severity, and the final factor (2 items; alpha = 0.60) measured affective social support. CONCLUSIONS We have developed a new instrument to measure the quality of life at the end of life that assesses empirically derived domains that are of demonstrated importance to dying patients, is acceptable to a seriously ill population, and exhibits excellent psychometric properties. Some items related to completion and preparation represent particularly new contributions to quality-of-life measurement.

Measuring quality of life at the end of life: validation of the QUAL-E.

OBJECTIVES To validate the QUAL-E, a new measure of quality of life at the end of life. METHODS We conducted a cross-sectional study to assess the instruments psychometric properties, including the QUAL-Es associations with existing measures, evaluation of robustness across diverse sample groups, and stability over time. The study was conducted at the VA and Duke University Medical Centers, Durham, North Carolina, in 248 patients with stage IV cancer, congestive heart failure with ejection fraction < or = 20%, chronic obstructive pulmonary disease with FEV1 < or = 1.0 1, or dialysis-dependent end stage renal disease. The main outcome measures included QUAL-E and five comparison measures: FACIT quality of life measure, Missoula-VITAS Quality of Life Index, FACIT-SP spirituality measures, Participatory Decision Making Scale (MOS), and Duke EPESE social support scales. RESULTS QUAL-E analyses confirmed a four-domain structure (25 items): life completion (alpha = 0.80), symptoms impact (alpha = 0.87), relationship with health care provider (alpha = 0.71), and preparation for end of life (alpha = 0.68). Convergent and discriminant validity were demonstrated with multiple comparison measures. Test-retest reliability assessment showed stable scores over a 1-week period. SIGNIFICANCE OF RESULTS The QUAL-E, a brief measure of quality of life at the end of life, demonstrates acceptable validity and reliability, is easy to administer, performs consistently across diverse demographic and disease groups, and is acceptable to seriously ill patients. It is offered as a new instrument to assist in the evaluation of the quality and effectiveness of interventions targeting improved care at the end of life.

Altered pituitary hormone response to naloxone in hypertension development.

&NA; Endogenous opioid regulation of blood pressure is altered during stress in young adults at risk for hypertension. We studied the effects of the opioid antagonist naloxone on the secretion of corticotropin and &bgr;‐endorphin during psychological stress in young adults with mildly elevated casual arterial pressures. Naloxone‐induced secretion of both corticotropin and &bgr;‐endorphin was significantly diminished in persons at enhanced risk for hypertension compared with the low blood pressure control group. Results suggest that opioidergic inhibition of anterior pituitary function is altered in hypertension development. (Hypertension 1989;14:636‐644)

Associations of Abdominal Fat With Perceived Racism and Passive Emotional Responses to Racism in African American Women

OBJECTIVES An excess in abdominal fat may predispose African American women to chronic health conditions such as diabetes and cardiovascular disease. Because stress may increase body fat in the center-body region, we used the waist-to-hip ratio (WHR) to examine associations between excess abdominal fat and perceived racism (a chronic stressor) and daily stress. Passive emotional responses to perceived racism, hypothesized to have particularly adverse effects, were also examined. METHODS We controlled for body mass index in multiple logistic regression models among 447 African American women who completed a telephone interview on perceived racism. RESULTS Passive emotional responses were not related to WHR (odds ratio [OR]=1.4; 95% confidence interval [CI]=0.8, 2.4). High perceived racism was associated with a low WHR in this population (OR=0.4; 95% CI=0.3, 0.8). However, high daily stress was related to a high WHR (OR=2.7; 95% CI=1.1, 6.7). CONCLUSIONS Findings support an association between daily stress and WHR but do not support our hypothesis that passive emotional responses to perceived racism increase abdominal fat. Further study of the stress physiology of perceived racism in African American women is warranted.

Toward Understanding Race Difference in Autonomic Reactivity

One of the most consistent findings in the cardiovascular epidemiologic literature is the higher resting blood pressure and greater prevalence of essential hypertension among black compared to white adults (Folkow, 1982, 1987). The higher rate of hypertension among blacks has been documented for males between the aged of 25 and 64 years and for females aged 25 through 74 years (Obrist, 1981). Not surprisingly, given the extraordinarily high rate of hypertension morbidity among blacks, this group also suffers disproportionately higher rates of hypertension-related mortality from heart disease, cerebral vascular disease, and renal disease (Matthews, Weiss, Detre, Dembroski, Falkner, Manuck, & Williams, 1986; Obrist, 1981).

Neuropeptide and cardiovascular responses to intravenous catheterization in normotensive and hypertensive blacks and whites.

Research suggests that heightened cardiovascular and neuroendocrine (typically catecholamine) responses to stressors may lead to the development of hypertension and that there may be race differences in patterns of reactivity that are potentially pathogenic. Certain neuropeptides exert profound effects on blood pressure (BP) and heart rate (HR), yet no published studies have examined relationships between these peptides, hypertensive status, race, and reactivity. Seventeen Black and 20 White normotensive and borderline-hypertensive male 19- to 50-year-olds underwent intravenous catheterization while cardiovascular and neuropeptide responses to the stress of being catheterized were examined. Results indicate that, in response to the stressor, Black hypertensives, showed significantly lower endorphin levels compared to Black normotensives, and White hypertensives showed significantly higher levels of beta-endorphin compared to White normotensives. Groups were not significantly different in endorphin levels at recovery. Black hypertensives also showed significantly higher stressor-induced HR and systolic and diastolic BP compared to White hypertensives and normotensives. Lower levels of beta-endorphin and lower urine sodium excretion were associated with higher BP and HR.

Autonomic Reactivity and Hypertension in Blacks: Toward a Contextual Model

The purpose of this chapter is threefold. For readers not familiar with the reactivity paradigm, we describe the underlying tenets and provide a summary of animal and human research examining the validity of the reactivity hypothesis. This is followed by a review of research on black—white differences in autonomic reactivity as a means of understanding the higher rates of hypertension among blacks. The chapter concludes with a description of a contextual model that provides a framework for understanding the research findings to date, and a stimulus for future research in this area.

Impact of Racial Discrimination and Hostility on Adrenergic Receptor Responsiveness in African American Adults

Objective Racial discrimination is increasingly recognized as a contributor to increased cardiovascular disease (CVD) risk among African Americans. Previous research has shown significant overlap between racial discrimination and hostility, an established predictor of CVD risk including alterations in adrenergic receptor functioning. The present study examined the associations of racial discrimination and hostility with adrenergic receptor responsiveness. Methods In a sample (N = 57) of young to middle-aged African American adults (51% female) with normal and mildly elevated blood pressure, a standardized isoproterenol sensitivity test (CD25) was used to evaluate &bgr;-AR responsiveness, whereas the dose of phenylephrine required to increase mean arterial pressure by 25 mm Hg (PD25) was used to assess &agr;1-AR responsiveness. Racial discrimination was measured using the Perceived Racism Scale and hostility was assessed using the Cook-Medley Hostility Scale. Results In hierarchical regression models, greater racial discrimination, but not hostility, emerged as a significant predictor of decreased &bgr;-adrenergic receptor responsiveness (&bgr; = .38, p = .004). However, moderation analysis revealed that the association between racial discrimination and blunted &bgr;-adrenergic receptor responsiveness was strongest among those with higher hostility (&bgr; = .49, 95% confidence interval = .17–.82, p = .004). In addition, hostility, but not racial discrimination, significantly predicted &agr;1-AR responsiveness. Conclusions These findings suggest racial discrimination was associated with blunted &bgr;-adrenergic receptor responsiveness, providing further evidence of the potential contribution of racial discrimination to increased CVD risk among African Americans. The adverse effects of discrimination on cardiovascular health may be enhanced in individuals with higher levels of hostility.