Lifetime discrimination and greater risk of high blood pressure in African Americans

July 17, 2020

Experiences of discrimination over a lifetime is associated with high blood pressure in African American adults, according to findings published this month in the journal Hypertension from researchers at the Urban Health Collaborative at Drexel University's Dornsife School of Public Health.

High blood pressure is linked with many life-threatening conditions, including stroke, heart disease and dementia, and is also associated with higher risk of severe illness from COVID-19. This connection between poor heart health and higher risk of severe symptoms suggests the findings may also provide insights into current racial disparities in patient outcomes during the pandemic.

The authors used survey responses from 1,845 African American adults living in Mississippi who participated in the Jackson Heart study (and did not have high blood pressure at the start of the study). Those who had a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure higher than 90 mm Hg and/or were taking medicine to manage their blood pressure at any follow up examination were considered to have developed hypertension.

Participants had a baseline visit between 2000 and 2004 and had two follow-up visits - one in 2005-2008 and the other in 2009-2013. At the time of study baseline patients reported previous experiences of discrimination via survey. The researchers counted instances of lifetime discrimination by counting any of nine domains -- such as in school/training, getting a job or housing, at work, etc. -- in which unfair treatment was reported.

After adjusting for gender, age, socioeconomic status and other high blood pressure risk factors, the team found that individuals reporting medium levels (in one to two domains) and high levels of lifetime discrimination (in three to nine domains) had a 49 percent and 34 percent increased risk for hypertension compared to those who reported low levels of lifetime discrimination (zero domains), respectively.

"Our findings in a large population show that the stress resulting from discrimination may have a major impact on the health of African Americans," said lead author Allana T. Forde, PhD, a postdoctoral research fellow at the Urban Health Collaborative.

The authors said the study could have implications for treating African American patients, but also renews attention towards the conditions in which people live and the significant influence of environment on health.

"Structural racism affects health in many ways. The experiences of discrimination investigated in this study represent only one of the many ways in which racism has measurable health consequences," said senior author and Urban Health Collaborative Director Ana Diez Roux, MD, PhD, dean and distinguished professor of Epidemiology at Dornsife School of Public Health. "Addressing racism is critical to promoting health and achieving health equity."

High blood pressure -- that is 130/80 or above according to current guidelines -- plagues 103 million adult Americans, nearly half of all adults. More than 40 percent of African American adults suffer from high blood pressure.
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Forde was awarded an American Heart Association grant to support this research. The Jackson Heart Study used in this paper is funded by the National Institutes of Health and implemented by the University of Mississippi Medical Center, Jackson State University; and Tougaloo College.

In addition to Forde and Diez Roux, study authors include Mario Sims, PhD, of University of Mississippi Medical Center; Paul Muntner, PhD of University of Alabama at Birmingham; Tené Lewis, PhD, of Emory University Rollins School of Public Health; Amanda Onwuka, PhD, of Nationwide Children's Hospital; and Kari Moore, from Drexel's Dornsife School of Public Health.

Read the full paper, "Discrimination and Hypertension Risk among African Americans in the Jackson Heart Study," at this link.

Drexel University

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