Abstract Body: Introduction: Perceived lifetime discrimination (PLD) is a psychosocial stressor contributing to elevated blood pressure, disproportionately impacting Black adults. The effect of PLD on mean arterial pressure (MAP)—an emerging marker for hypertension risk—may occur indirectly through anger expression, sleep disturbances, and systemic inflammation. Prior studies have not simultaneously assessed the mediating roles of these factors in the association between PLD and MAP.
Objective: Explore whether anger expression, sleep disturbances, and c-reactive protein (CRP) serially mediate the association between PLD and MAP among Black adults.
Methods: This study utilized data from 1717 Black adults (56.8% female) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. PLD was reported at baseline and was assessed by summing self-reported events of unfair treatment attributed to race, sex, or socioeconomic status (continuous). Outward expression of anger was assessed as the sum of 8 subscale item responses (1-almost never to 4-almost always). Sleep disturbances included binary indicators of trouble falling asleep (yes vs. no), waking up several times (yes vs. no), and short sleep duration (<6 h vs. ≥6 h), as well as subjective sleep quality (ordinal scale from 0-very bad to 4-very good). MAP was computed as [Diastolic Blood Pressure + (Systolic Blood Pressure - Diastolic Blood Pressure)]/3. Multigroup path analyses adjusted for age, smoking status, education level, income, and antihypertensive medication use at baseline.
Results: Among females, two significant indirect effects were found such that increases in PLD were indirectly associated with elevated CRP levels and higher MAP via both shorter sleep (β = 0.012, 95% CI [0.005, 0.056]) and worse sleep quality (β = 0.013, 95% CI [0.007, 0.048]). Among males, no indirect effects were observed; all paths were insignificant.
Conclusions: This study identified sequential psychological (anger-out), behavioral (sleep disturbances), and biological (CRP) pathways through which PLD impacts MAP among Black female adults. Sex-specific pathways highlight the importance of anger regulation and healthy sleep to mitigate discrimination-related cardiovascular risk among Black adults.