Hearts & hate: A lifetime of discrimination raises hypertension risk among African Americans

DALLAS — Constantly being subjected to racism and discrimination can seriously harm an individual’s mental state and sense of self-worth. Now, a new study concludes that a lifetime’s worth of discrimination can also raise the risk of high blood pressure, or hypertension, among African Americans.

Using data from group of nearly 2,000 African Americans in Mississippi, researchers say those who reported medium to high levels of lifetime discrimination have a higher risk of hypertension.

“Previous studies have shown that discrimination affects African Americans’ health; however, this research is one of the first large, community-based studies to suggest an association between discrimination over a lifetime and the development of hypertension among a large sample of African American men and women,” says first study author Allana T. Forde, Ph.D., M.P.H., a postdoctoral research fellow at the Urban Health Collaborative at Drexel University.

“African Americans continue to be disproportionately affected by hypertension, making it imperative to identify the drivers of hypertension in this population,” Forde adds. “Greater lifetime discrimination was associated with an increased risk for hypertension among African Americans in this study, which reflects the impact of cumulative exposure to stressors over one’s lifetime and the physiological reactions to stress that contribute to deleterious health outcomes.”

Link between discrimination, hypertension in African Americans

In total, data on 1,845 African Americans between the ages of 21 and 85 were included in this study. All of that information was originally collected as part of the The Jackson Heart Study, a research project focused on cardiovascular disease among African Americans living in Jackson, Mississippi.

At the beginning of the observation period, between the years 2000 and 2004, none of the participants showed any signs of high blood pressure. However, each adult was asked to come back for two additional checkups; one at some point between 2005 and 2008, and a second between 2009 and 2013.

Meanwhile, participants were asked about their experiences with discrimination and racism via a series of home interviews, surveys, and in-clinic examinations.

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Participants were classified as having high blood pressure if they were taking any hypertension medication, had a systolic blood pressure reading of 140 mm Hg or higher, or displayed a diastolic blood pressure reading higher than 90 mm Hg during additional checkups.

During the entire follow up period, more than half of the participants (954 people, 52%) developed high blood pressure. Compared to participants who hadn’t encountered all that much discrimination over the course of their life, those who reported medium levels of discrimination were 49% more likely to develop hypertension. This held true even after accounting for other potential risk factors.

Using discrimination as a health factor in the future

“The study has important implications for patient care and population health,” Forde says. “Traditional risk factors, such as diet and physical activity, have been strongly correlated with hypertension, yet important psychosocial factors like discrimination, which also have the potential to negatively impact health, are rarely considered when evaluating the risk for hypertension among African Americans in health care settings.”

“Our findings highlight the need for health care professionals to recognize discrimination as a social determinant of health. Health care professionals who understand the importance of unique stressors like discrimination that impact the health of African Americans will be better equipped to provide optimal patient care to this population,” she continues. “However, medical care is not enough. More broadly, our results suggest how social determinants such as racism and discrimination affect health in measurable ways. Addressing these factors is critical to reducing rates of chronic diseases.”

More research is necessary in different regions of the United States to validate these findings. Nonetheless, the study’s authors say their work has brought to light yet another way in which discrimination negatively impacts African Americans.

The study is published in Hypertension.

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