A daily diary examination of the influence of anticipated and vicarious stressors on blood pressure

Hypertension (defined as in-office blood pressure ≥130/80 mmHg) is the most important modifiable risk factor for cardiovascular disease, the leading cause of death and disability among adults worldwide. Psychosocial stressors (e.g., financial stress, interpersonal violence, job strain) are associated with elevations in blood pressure across the life course. However, prior research on the effects of psychosocial stressors on blood pressure has neglected the role of anticipated stressors (i.e., expectation of experiencing stressful events) and vicarious stressors (i.e., hearing about or witnessing stressful events that happen to others). Further, prior work has included only limited examination of the affective, behavioral, and physiological mechanisms linking psychosocial stressors with blood pressure in individuals’ real-world environments. Given these limitations, we posit that researchers have previously underestimated the scope and impact of psychosocial stressors on blood pressure. We have compelling pilot data showing that greater reports of daily anticipated psychosocial stressors are associated with higher home systolic blood pressure (a stronger predictor of future cardiovascular events than in-office blood pressure) among adults. The goal of this 1-week daily diary study is to estimate the influence of anticipated and vicarious psychosocial stressors on home blood pressure. We will conduct the first study to robustly examine mechanisms linking anticipated and vicarious psychosocial stressors with blood pressure in individuals’ real-world environments. We will recruit a sample of 400 adults (ages 18-64) without diagnosed hypertension or cardiovascular disease. Participants will complete a structured interview followed by 1 week of: (1) twice-daily structured electronic diaries that assess daily anticipated and vicarious psychosocial stressors, (2) collection of saliva samples to assess salivary stress biomarkers (i.e., salivary cortisol and salivary alpha-amylase), (3) continuous wrist-worn actigraphy, and (4) twice-daily home blood pressure monitoring. Our specific aims are to: (1) Determine the influence of anticipated and vicarious psychosocial stressors on mean home systolic blood pressure and mediators of these associations (e.g., salivary cortisol, anxiety) and (2) Examine differences in anticipated and vicarious psychosocial stressors and mean home systolic blood pressure across different groups and the interactions between them. We will also explore moderators (e.g., socioeconomic status, adverse childhood experiences) of the influence of anticipated and vicarious psychosocial stressors on mean home systolic blood pressure. This study will provide the first evidence of mechanisms by which anticipated and vicarious psychosocial stressors influence blood pressure. If we find that anticipated and/or vicarious psychosocial stressors influence blood pressure—even in the absence of actual stressful events—it will shift how we think about the design of interventions for cardiovascular disease risk reduction. This study is a critical step for identifying mechanistic targets for future interventions to reduce the harmful effects of anticipated and vicarious psychosocial stressors on cardiovascular health.