Facing Discrimination Could Increase Hypertension Risk in African Americans

Allana Forde, PhD, MPH

While mountains of data have described the disparities in care received by people of color in the US, a new analysis of the Jackson Heart Study is highlighting the potential impact of lifetime discrimination on cardiovascular health.

Results of the analysis, which assessed the impact of discrimination as a chronic stressor, suggest discrimination in day-to-day life and over time can take be detrimental beyond the mental health and well-being of African American men and women.

"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,” said Allana Forde, PhD, MPH, a postdoctoral research fellow at the Urban Health Collaborative at Drexel University, in a statement from the American Heart Association. 



To learn more about the impact of discrimination on cardiovascular health, investigators designed their study to assess associations of everyday and lifetime stress from discrimination with incident hypertension and whether these associations differed by gender, age, discrimination attribution, and coping responses in patients from the Jackson Heart Study. From the study, which is the largest study of cardiovascular disease in African Americans, investigators identified a total of 1845 patients without baseline hypertension and with self-reported data related to discrimination.



Of note, investigators measured both every day and lifetime discrimination at visit 1 of the Jackson Heart Study. Everyday discrimination was assessed across 9 domains and overall scores ranged from 1-7. Lifetime discrimination was measured across 9 domains and scores ranged from 0-9.

For patients who reported experiencing discrimination, further assessment evaluated the most commonly used coping strategy from a previously established list of 12 strategies. These strategies were divided into 3 separate categories—active coping, passive coping, and external/other coping.

For the purpose of analysis, investigators defined having hypertension as taking antihypertensive medication or, having a systolic blood pressure of 140 mmHg or greater or a diastolic blood pressure of 90 mmHg or greater at visits 2 or 3. Additionally, investigators included age, gender, BMI, hypertension risk factors, and socioeconomic status as potential confounders in their analysis.

Of the 1845 participants included in the analysis, 954 developed hypertension. In comparison to those who did not develop hypertension, those with hypertension were older, less likely to be college-educated, have a higher BMI, were more likely to be current or former smokers, and engaged in less physical activity.

In models adjusted for age, gender, socioeconomic status, and hypertension, results indicated medium (HR, 1.49; 95% CI, 1.18-1.89) and high (HR, 1.34; 95% CI, 1.07-1.68) levels of lifetime discrimination were associated with greater risk of incident hypertension than low levels. 



Further analysis indicated higher stress from lifetime discrimination was associated with increased hypertension risk after adjustment for demographic variables (HR, 1.19; 95% CI, 1.01-1.40), but the association was attenuated upon adjustment for hypertension risk factors (HR, 1.14; 95% CI 0.97-1.35).

"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," Forde said, in the aforementioned statement.

Investigators noted multiple limitations within their study. Limitations included inability to track changes in discrimination over a long follow-up period, the specific location limiting generalizability, and reliance on self-reported data.



This study, “Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study,” was published in Hypertension.