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Changes in Financial Strain Over Three Years, Ambulatory Blood Pressure, and Cortisol Responses to Awakening

From the Department of Epidemiology and Public Health, University College London, London, United Kingdom.

Address correspondence and reprint requests to Andrew Steptoe, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, United Kingdom. E-mail: a.steptoe{at}ucl.ac.uk

Objective: Chronic psychosocial stress has been associated cross-sectionally with ambulatory blood pressure and with salivary cortisol, but there have been few longitudinal studies of the effects of changes in chronic stress. We assessed the influence of changes in financial strain on ambulatory blood pressure and salivary cortisol.

Methods: Data were analyzed from 160 men and women age 47 to 59 years at the first assessment (T1) who repeated ambulatory monitoring 3 years later (T2). We analyzed change in financial strain as a continuous variable, and specifically compared people who did and did not report an improvement in financial strain.

Results: Change in financial strain was associated with change in ambulatory systolic pressure after controlling for T1 ambulatory systolic pressure, gender, socioeconomic position, age, smoking, body mass index, and T1 financial strain (p = .041). Systolic pressure at T2 was lower in the improved financial strain (121.7 ± 11.2 mm Hg) than in the worse/no change group (125.5 ± 11.5 mm Hg; p = .029). The corresponding diastolic pressures averaged 78.5 ± 7.1 mm Hg and 80.7 ± 7.9 mm Hg, respectively (p = .061). The cortisol awakening response (difference between waking and 30 minutes later) was lower (p = .048) in men who reported improved financial strain, controlling for T1 cortisol response, socioeconomic position, age, smoking, time of waking, and T1 financial strain. There were no differences in the slope of cortisol decline over the day or in evening values.

Conclusion: These longitudinal data extend cross-sectional findings in showing associations between favorable changes in chronic stress and reduced cardiovascular and neuroendocrine activation in everyday life.

Key Words: ambulatory blood pressure • cortisol • chronic stress • financial strain

Abbreviations: CAR = cortisol awakening response; BMI = body mass index; SEP = socioeconomic position; CHD = coronary heart disease; CI = confidence interval.

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