Lifetime Discrimination Linked with Higher Hypertension Risk for Black Americans

Discrimination over a lifetime was identified as a chronic stressor potentially linked with higher blood pressure in black Americans, a new analysis suggests.

“African Americans have a higher risk of hypertension compared with other racial or ethnic groups in the United States,” the authors wrote. “One possible explanation for this disparity is discrimination. Few studies have examined the association between discrimination and incidence of hypertension.”

The authors looked at everyday discrimination, lifetime exposure, and stress and how those forms were associated with gender, age, discrimination attribution, and coping responses. The study included 1,845 participants in the Jackson Heart Study (aged 21 to 85 years who had no hypertension at study baseline). The authors used Cox proportional regression for estimates of links between discrimination and incident hypertension.

During follow-up, 52% of patients developed hypertension. Medium vs. low levels of discrimination (HR-1.49; 95% CI, 1.18 to 1.89) and also high vs. low levels of lifetime discrimination (HR=1.34; 95% CI, 1.07 to 1.68) were both linked with an elevated incidence of hypertension. There were no interactions between age, gender, attribution or coping. After adjusting for demographics, elevated stress from lifetime exposure was linked with higher hypertension risk  (HR=1.19; 95% CI, 1.01 to 1.40). The link, however, was attenuated following adjustment for hypertension risk factors (HR-1.14; 95% CI, 0.97 to 1.35).

“Our findings highlight the need for health care professionals to recognize discrimination as a social determinant of health,”said Allana T. Forde, PhD, MPH, the lead study author and a postdoctoral research fellow at the Urban Health Collaborative at Drexel University in Philadelphia, Pennsylvania,” in a press release about the study. “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 added: “”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.”

The analysis was published in Hypertension.