Sleep Mediates the Relationship Between Stress and Blood Pressure in Older African American Women: A Cross-Sectional RiSE Study

Objectives To examine whether sleep quality mediates the relationship between perceived stress and blood pressure among older African American women (AAW).Methods A cross-sectional analysis was conducted using baseline data from older AAW (aged 50–75) enrolled in the Resilience, Stress, and Ethnicity (RiSE) study. Perceived stress was assessed using the 10-item Perceived Stress Scale, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Blood pressure was measured three times and averaged to calculate mean systolic and diastolic blood pressure. Structural equation modeling was used to test mediation, adjusting for age, body mass index, and antihypertensive medication use.Results Among 158 women (mean age 63.0 ± 6.7 years), 57.6% were taking antihypertensive medications, mean systolic blood pressure was 129.5 ± 15.4 mmHg, and mean PSQI score was 7.6 ± 3.5, indicating poor sleep quality. Perceived stress was associated with poorer sleep quality (b = 0.21, p < .001), and poorer sleep quality was related to higher systolic blood pressure (b = 0.81, p = .037). Sleep quality significantly mediated the effect of stress on systolic blood pressure (b = 0.17, p = .049), with no direct effect observed (b = 0.10, p = .594).Conclusion Sleep quality mediated the relationship between perceived stress and systolic blood pressure in older AAW. These findings support the role of sleep as a behavioral mechanism linking stress to cardiometabolic risk and suggest the importance of developing culturally tailored sleep interventions to mitigate the adverse cardiometabolic effects of stress in this high-risk population.