Early Cardiometabolic Vulnerability: Exploring Sleep, Depression, and Hypertension in Rural Communities

Abstract Background Cardiometabolic disease risk is disproportionately high in rural U.S. communities, where behavioral and metabolic determinants often intersect. However, relationships between sleep, psychological distress, and blood pressure variability remain understudied in rural communities. Objective To assess how sleep, depressive symptoms, and metabolic indicators influence blood pressure outcomes in rural adults. Methods In this exploratory descriptive cross-sectional study, survey and clinical measurement data were collected from N = 68 participants. Data were analyzed using descriptive statistics, bivariate correlations, and hierarchical regression. Results Age, sex, and sleep were positively associated with blood glucose. Depressive symptoms were inversely related to blood glucose and BMI. Depressive symptoms and sleep dysfunction were positively associated with blood pressures, but in some models were attenuated by sleep, whereas sleep was related to elevated blood glucose. Age was inversely associated with blood pressure and antihypertensive medication use did not account for this relationship. Among non-medicated participants, mean blood pressures were significantly elevated. In subgroup analyses, the youngest non-medicated adults (ages 29–33) had markedly higher mean arterial pressure. Conclusions Sleep-related impairment and depressive symptoms were related to BP indices and indicators of metabolic disruption and inflexibility in this rural community sample. The effect of depressive symptoms on BP outcomes was consistent with autonomic and vascular tone mechanisms but was attenuated by sleep. Younger participants exhibited disproportionately high untreated blood pressures, highlighting the possibility that cardiometabolic vulnerability may manifest earlier in rural communities than typically recognized. Results support early detection initiatives and future biobehavioral-informed research targeting younger populations.