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Adverse social factors can predict hypertension--but how?

It is well documented that cardiovascular disease and risk factors, including hypertension, tend to cluster in people from lower social classes, with lower incomes and with less education.1 It is, however, less obvious why this is the case, and several explanations have been proposed. Adverse social factors are often associated with a poor lifestyle including less healthy diet, less exercise, more smoking, and therefore an increased preponderance to abdominal obesity and the so-called metabolic syndrome.2 This will increase the risk of developing hypertension in susceptible individuals, but other explanations have also been proposed. The influence of psychosocial stress on blood pressure regulation has been studied in various settings. In one population-based study from Sweden it was shown that job strain at the workplace could influence blood pressure increase, but more so in men than in women.3 Other studies have shown that a number of biological pathways are possible to link psychosocial stress with increased levels of cardiovascular risk, including activation of the sympathetic nervous system.4 Adverse social factors, for example less education, could also influence self-help knowledge and the way that patients seek and get medical attention for various medical needs, including risk factor control. This could mean, for example, that the subjects from less socially privileged strata of the population could have less likelihood of participating in screening activities for hypertension, or receive less health care. In addition, the compliance with medical treatment could also be suboptimal in these subjects and therefore the risk factor control also less optimal. This is influenced by availability of health care resources but also by … 

Corresponding author. Email address: Peter.Nilsson{at}med.lu.se