Relationship Between Psychosocial Stress and Blood Pressure: The National Heart, Lung, and Blood Institute Family Heart Study.



Various domains of psychosocial stress have been significantly related to blood pressure. However, ambiguity is present in how these relationships are defined in the literature.


To add to the existing literature and examine the relationship between psychosocial stress (financial strain and job strain) and other cofactors on blood pressure.


This secondary analysis is designed to analyze the relationship between levels of job and financial stress and blood pressure outcomes among participants in the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study 2004-2008. The descriptive, cross-sectional design uses data from a subset of study participants, 350 White and 195 Black (n = 545), 338 female (62%), and all aged 18-56 years. Psychosocial stress was measured using the Singh Stress Scale. Resting systolic (SBP) and diastolic (DBP) blood pressure values obtained on a stress reactivity protocol day in the primary study, as well as calculated mean arterial pressure (MAP) were used for this analysis. Multivariate linear regression analyses were used to explore the relationship between psychosocial stress and blood pressure.


In this young cohort, self-report of either financial strain or job strain was associated with lower blood pressure levels than those of participants who reported neither stressor. Differential sex and race effects appear to contribute to these results. Blood pressure levels were not significantly associated with self-report of both stressors.


Understanding the effects of various forms of stress on blood pressure may inform more precise HTN risk-factor screening and interventions to improve BP management.





Published Version (Please cite this version)


Publication Info

Nwanaji-Enwerem, Uzoji, Elijah O Onsomu, Dionne Roberts, Abanish Singh, Beverly H Brummett, Redford B Williams and Jennifer R Dungan (2022). Relationship Between Psychosocial Stress and Blood Pressure: The National Heart, Lung, and Blood Institute Family Heart Study. SAGE open nursing, 8. p. 23779608221107589. 10.1177/23779608221107589 Retrieved from

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Abanish Singh

Assistant Professor in Psychiatry and Behavioral Sciences

With a unique skill set resulting from outstanding training, my sole aim was to help improve human health through cutting-edge translational research. Specifically, I have been interested in illuminating the mechanisms responsible for the causes and progression of the leading public health conditions, which may help with the development and enhancement of precision medicine.  As part of this endeavor, I also became interested in studying the measurement of biobehavioral risk factors and environmental stressors and their interactions with genes that may influence cardiovascular disease (CVD) risk factors and endophenotypes, adversely affecting the CVD pathways.

I joined medical research with my early research training on computational biology, high-throughput genomics, next-gen DNA sequencing, genome-wide studies, and big data analytics, which resulted in some of prominent findings on human genome (PMID: 18048317, PMID: 20223737, PMID: 20598109, PMID: 21703177). These findings included a significant contribution to the scientific community’s understanding that I made during my postdoctoral fellowship with Dr. David Goldstein at Duke Center for Human Genome Variation that how well RNA-Seq can identify human coding variants just using a small fraction of genome (transcriptome) as compared to whole genome (PMID: 20598109). This work was important not only scientifically, but also in pragmatic terms, given the high cost of sequencing.

In relatively recent work I discovered a novel CVD risk gene EBF1, where  a common genetic variant contributed to inter-individual differences in human central obesity, fasting blood glucose, diabetes, and CVD risk factors in the presence of chronic psychosocial stress (PMID: 25271088). This work demonstrated the genetic variant-specific significant path from chronic psychosocial stress to common carotid intimal–media thickness (CCIMT), a surrogate marker for atherosclerosis, via central obesity and fasting glucose. I also developed an algorithm to create a synthetic measure of stress using the proxy indicators of its components (PMID: 26202568).  Other more recent work has elucidated the race, sex, and age related differences in the EBF1 gene-by-stress interaction (PMID: 33077726), which suggests the need for careful evaluation of environmental measures in different ethnicities in cross-ethnic gene-by-stress interaction studies.

More recently, I have expanded my research interest in studying the genetic architecture of Alzheimer’s disease (AD) and the role of psychosocial stress in modifying the effect of genetic variants on the disease risks.


Beverly H. Brummett

Associate Professor Emeritus in Psychiatry and Behavioral Sciences

In the early part of my career, my work generally focused on examining psychosocial determinants or correlates (e.g., emotion, personality, and socioeconomic status) of cardiovascular disease.  However, in the past several years, my work has also expanded to include examining how stressful emotional responses, combined with proposed genetic markers, influence metabolic functioning, cognitive decline, functional capacity and quality of live in the elderly, depressive symptomology, and major depressive disorder.  I also have an interest in statistical methodology. 


Redford B. Williams

Professor Emeritus of Psychiatry and Behavioral Sciences

My research aims to identify psychosocial factors that are involved in the pathogenesis and course of major medical disorders, to characterize the biobehavioral mechanisms whereby such factors influence disease, and to develop both behavioral and pharmacologic means of preventing or ameliorating the adverse impact of psychosocial factors on health and disease. Specific projects that are currently active include: 1) The influence of hostile personality, social isolation, depression and other psychosocial risk factors upon the development and course of cardiometabolic disease; 2) Biological and genetic mechanisms whereby psychosocial risk factors influence disease development and course; and 3) Behavioral and pharmacologic approaches to ameliorate impact of psychosocial risk factors on disease risk and course.

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