‘Lifetime of discrimination’ equals increased hypertension in African Americans

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Blacks 40 percent more likely to have high blood pressure

by Renee P. Aldrich
For New Pittsburgh Courier
It’s a well-established fact that African Americans suffer disproportionately from most all chronic health disorders, including heart disease, diabetes and higher rates of various cancers. Researchers and health care providers have identified some African Americans’ lifestyle choices, such as smoking, poor eating habits, obesity and lack of exercising as the things that contribute to rampant health disparities.

It would seem that this would be “good news” because overall, a “lifestyle” is something in which people have a choice. African Americans can choose not to smoke or have poor eating habits.

However, in data extracted from a study, which was then published by the American Heart Association in July, it’s been determined that Blacks have an even more insidious adversary over which they have no control, which keeps Blacks at the top of the list for chronic disease and early death—discrimination.

Experiencing “Lifetime Discrimination,” as it was called by the AHA, is a chronic stressor that was found to increase the risk for hypertension, or high blood pressure, in African Americans.

There have been other studies showing that discrimination affects African Americans’ health; however, this research, which was based on 1,845 African Americans between ages 21 and 85 in the Jackson, Miss., is one of the first large, community-based studies to suggest a direct link between discrimination and hypertension.

Researchers reviewed data on the African Americans who were in enrolled in the “Jackson Heart Study,” which focused on cardiovascular disease among African Americans in that region. The Jackson Heart Study is widely recognized as one of the most comprehensive and ongoing institutions that investigate the causes of cardio-vascular diseases in African Americans and how to best prevent them.

The study participants did not have hypertension during the first visit, which occurred between 2000 and 2004.

But as time went on, as more and more conditions from the participants were extracted from the study, it was found that more than half of the participants (52 percent) developed hypertension. The AHA said that the participants who reported medium levels compared to low levels of lifetime discrimination had a 49 percent increased risk for hypertension after accounting for other risk factors.

The AHA said that participants were defined as having hypertension if they reported they were taking blood pressure-lowering medication, had a systolic blood pressure of 140 mm Hg or above, or a diastolic blood pressure higher than 90 mm Hg at later visits.

“The study has important implications for patient care and population health,” said Allana T. Forde, Ph.D., in a release by the AHA. Forde was the study’s first author. “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.”

Forde also said in the release that the study’s 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.”

DR. ESA DAVIS, right, with the American Heart Association’s Karen Colbert.

Dr. Esa Davis, Associate Professor of Medicine, Clinical and Translational Science and Director of UPMC Tobacco Treatment Service, in an exclusive interview with the New Pittsburgh Courier, shared that there are several reasons this report is so important.

“First, is that it can help expand the dialogue around treating hypertension, and brings attention to why, even with intervention and treatment, the rate of disparity continues to be so high. The Jackson (study’s intention) … was to document and highlight that racism and discrimination can and does affect the health of African Americans, especially over the course of someone’s lifetime—which would include heart disease and diabetes.”

Dr. Davis continued: “But most specifically, the study was set around the hypertension piece, because it is more insidious—known as the ‘silent killer’ since too often there are no real symptoms until such time as high blood pressure goes unmanaged for so long and the patient suffers a stroke or kidneys begin to fail, developing the need to be on dialysis.”

Lora Ann Bray, Manager of Community Partnerships, Education, and Training at the University of Pittsburgh Center for Health Equity in the Graduate School of Public Health, said that “hypertension increases one’s risk of stroke and heart attack and it is still the number one killer of all Americans. By including racism, which manifests in discriminatory practices and policies, as a risk factor for heart disease, we expand the conversation to talk about social factors that impact health outcomes.”

Bray also suggests that a more holistic approach is needed that integrates mind, body, and soul to help relieve the burden of cumulative stress on African Americans. “While we advocate for policy change, public health professionals can design interventions to strengthen community resiliency,” she said.

Studies like these have affirmed the role of racism and discrimination as factors in the disparate numbers of African Americans who suffer from hypertension. And, as the nation knows, racism and discrimination in society are things that African Americans have no control over.

When it comes to things Blacks do have control over, such as certain lifestyle choices, Dr. Davis said that “there are still things we can do on a daily basis that can make a difference in health outcomes.”

Dr. Davis said to be aware of a person’s salt intake. “Learn to read labels to understand how much sodium is in the products we purchase. If we can’t go to the gym, we can start out with a walk around the block.”
Also, eating fruits and vegetables is important, though it sometimes can be an economic challenge.

“And for sure we should begin by eliminating tobacco products,” Dr. Davis told the Courier. “Not only is that far too expensive,” but eliminating tobacco products “can add years on our life.”

Researchers agree that additional studies with African Americans in other regions of the U.S. would be warranted to confirm the findings of this study, which was based in Jackson. However, these results add to a large body of work that’s already documented the impact of discrimination on the health of African Americans. Data from the U.S. Department of Health and Human Services Office of Minority Health reported that Black adults are 40 percent more likely to have high blood pressure than Whites, and are less likely than their White counterparts to have their blood pressure under control.

The HHS Office of Minority Health also said that African American women are 60 percent more likely to have high blood pressure, compared to White women.

Strategies to reduce health inequities and improve health are needed to address these broader social determinants.

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