Interplay of Race and Neighborhood Deprivation on Ambulatory Blood Pressure in Young Adults

Background Ambulatory blood pressure ( BP ) monitoring measures nighttime BP and BP dipping, which are superior to in-clinic BP for predicting cardiovascular disease ( CVD ), the leading cause of death in America. Compared with other racial/ethnic groups, Black Americans exhibit elevated nighttime BP and attenuated BP dipping, including in young adulthood. Social determinants of health contribute to disparities in CVD risk, but the contribution of neighborhood deprivation on nighttime BP is unclear. Therefore, we examined associations between neighborhood deprivation with nighttime BP and BP dipping in young Black and White adults. Methods We recruited 21 Black and 26 White participants (20 M/27 F, mean age: 21 years, body mass index: 25±4 kg/m[2][1]) for 24-hour ambulatory BP monitoring. We assessed nighttime BP and BP dipping (nighttime:daytime BP ratio). The area deprivation index ( ADI ) was used to measure neighborhood deprivation. Associations between ADI and ambulatory BP were examined. Results Black participants exhibited higher nighttime diastolic BP compared with White participants (63±8 mmHg vs 58±7 mmHg, p =0.003), and attenuated BP dipping ratios for both systolic (0.92±0.06 vs 0.86±0.05, p =0.001) and diastolic BP (0.86±0.09 vs 0.78±0.08, p =0.007). Black participants experienced greater neighborhood deprivation compared with White participants (ADI scores: 110±8 vs 97±21, p <0.001), and ADI was associated with attenuated systolic BP dipping (ρ=0.342, p =0.019). Conclusions Our findings suggest neighborhood deprivation may contribute to higher nighttime BP and attenuated BP dipping, which are prognostic of CVD, and more prevalent in Black adults. Targeted interventions to mitigate the effects of neighborhood deprivation may help to improve nighttime BP. Clinical Trial Registry URL: ; Unique identifier: [NCT04576338][2] Clinical Perspective ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by National Institutes of Health (NIH) grants K01HL147998 and R15HL165325 (to ATR), R15HL140504 (to TEFR), UL1TR003096 (pilot funding to ATR and TL-1 Fellowships to SJ and BAL), K99/R00DK119413 (to EYG), Auburn University Presidential Graduate Research Fellowship (to BAL), and U.S. Department of Veterans Affairs Grants IK2RX003670 (to KB). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Study protocol and procedures were approved by the Institutional Review Board for Research Involving Human Subjects of Auburn University, and the trial was registered on clinicaltrials.gov ([NCT04576338][2]). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data will be made available by the corresponding author upon reasonable request. * ACE : adverse childhood experience BP : blood pressure CVD : cardiovascular disease DBP : diastolic blood pressure ET-1 : endothelin-1 M-index : melanin-index MVPA : moderate to vigorous physical activity PRA : plasma renin activity SDoH : social determinants of health SBP : systolic blood pressure [1]: #ref-2 [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04576338&atom=%2Fmedrxiv%2Fearly%2F2023%2F09%2F12%2F2023.09.11.23295160.atom