Hypertension, or high blood pressure, leads to a host of health complications. It drastically increases the risk of stroke, chronic kidney disease, aneurysm, coronary artery disease, and dementia. And, it disproportionately affects Black Americans.
Now, a new study shows that a lifetime of experiencing discrimination is associated with a significantly higher likelihood of developing hypertension. In fact, study participants who experienced discrimination over their life were 49 percent more likely to develop hypertension than study participants who rarely felt discriminated against.
“This study shows that the discrimination African Americans face on a daily basis is an overlooked social determinant of health,” says Allana Forde, Ph.D., an epidemiologist at the Urban Health Collaborative at Drexel University in Philadelphia, and lead author of the study, published in the August 2020 issue of the journal Hypertension. “While past studies have shown that acute discriminatory events raise stress levels, we wanted to see what effect it had over a long period of time.”
Dr. Forde emphasized that the results of her study show how hypertension needs to be considered more holistically than just a symptom of unhealthy eating habits, lack of exercise, and poor stress-management.
“This adds to the argument that racism is a public health issue,” says Forde. “We can tell people to reduce stress in their lives and give them strategies to cope with it, but those often ignore the brutal reality that facing discrimination because of your skin color is pervasively stressful.”
To conduct the study, Forde and her team analyzed data on 1,845 African Americans, ages 21 to 85, enrolled in The Jackson Heart Study, which focused on cardiovascular disease among African Americans around the Mississippi capital.
None of the participants had hypertension at the onset of the study. There were two follow up study visits, one between 2005 and 2008 and a second between 2009 and 2013. Results showed that 52 percent of study participants developed hypertension over the follow-up period.
Over the 13 years that the patients were tracked, the study participants reported their experiences of discrimination through interviews, clinical exams, and at-home questionnaires. The results were clear; the more a participant experienced discrimination, the more likely they were to suffer from high blood pressure.
Forde readily admits that the observational nature of the study makes it impossible to prove cause and effect, despite the robust trove of data she and her colleagues analyzed. And yet, she compliments the nature of the Jackson Heart Study for its consideration of Black American experiences with discrimination as a determinant of heart health.
“We’re talking about a state with a deep history of racist and discriminatory policies, so it seems naïve not to think that would impact a person’s mental and physical health,” says Forde.
In fact, Mississippi just became the last state in the country to remove the Confederate emblem from its state flag.
“For an African American seeing that Confederate symbol waving on the state flag all over Jackson, it’s a constant reminder of your place in society and the constant threat of racism,” says Willie Lawrence, MD, chief of cardiology at Research Medical Center in Kansas City, who was not involved in the study. “That’s why this observational study is very provocative and suggestive that if we want to impact the healthcare of patients we need to pay attention to the societal factors that influence their psyche and psychology, which then have physical manifestations.”
Dr. Lawrence noted that while we all experience moments of hypertension in response to stress, Black Americans often experience constant stress from discrimination that heightens and prolongs anxiety. When a leisurely walk, a relaxing Sunday drive, or a morning jog are safety risks, it causes persistent stress over a lifetime, which contributes to a hypertension diagnosis.
“One of the major takeaways from the study is that intervention efforts to prevent hypertension need to acknowledge and focus on those societal elements that cause chronic stress in our lives,” says Lawrence.
Forde agreed with that assessment and would like to see the healthcare industry focus on developing strategies to help patients cope early on with the stress from discrimination.
“Ridding the world of discrimination would be nice, but that’s a pipe dream right now,” she says. “A realistic step for healthcare professionals is to identify healthy coping mechanisms and social supports that help people handle discrimination.”
Without those interventions and improvements in society, Lawrence notes that discrimination kills Black Americans in various ways.
“Racism is a public health emergency that’s killing Black people,” he says. “It’s a slow death from hypertension or a fast death from a cop’s stranglehold,” he says.