HTN Linked to Being on the Receiving End of Racism

African Americans experiencing more unfair treatment based on race were more likely to develop high blood pressure (BP) in subsequent years, according to an analysis of the Jackson Heart Study.

Experiencing lifetime levels of racial discrimination deemed intermediate (adjusted 1.49, 95% CI 1.18-1.89) or high (adjusted HR 1.34, 95% CI 1.07-1.68) was associated with a higher incidence of hypertension, compared with individuals reporting low exposure to discrimination.

The associations appeared similar across gender, age, attribution, and coping mechanisms, according to a group led by Allana Forde, PhD, MPH, of Drexel University in Philadelphia, reporting online in Hypertension.

Higher stress from lifetime discrimination was linked to hypertension risk, but this lost statistical significance after adjustment for hypertension risk factors (adjusted HR 1.14, 95% CI 0.97-1.35).

“Our results suggest that discrimination is a chronic stressor that may increase the risk of hypertension,” study authors concluded.

“Future studies should measure discrimination at different time points to capture the impact that dynamic changes in unfair treatment may have on hypertension risk, and measure additional moderators, such as racial residential segregation and social support, to better understand how psychosocial resources may mitigate and modify the impact of discrimination on hypertension,” Forde and colleagues said.

The Jackson Heart Study was a prospective cohort study of adult African Americans living in Jackson, Mississippi.

Participants self-reported experiences of discrimination during a baseline visit in 2000-2004. Responses were recorded on the Everyday Discrimination Scale (how often participants experienced recurrent episodes of unfair treatment) and Lifetime Discrimination Scale (lifetime occurrence [yes/no] of unfair treatment in nine domains, added up to generate the discrimination score).

The current analysis included the 1,845 adults without hypertension at baseline who completed follow-up visits (once in 2005-2008 and again in 2009-2013).

Over the years, 52% of participants developed hypertension, defined by antihypertensive medication use or having a systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg.

Everyday discrimination was moderately correlated with lifetime discrimination. Everyday discrimination was not associated with incident hypertension after adjustment, according to Forde’s team.

The findings from the study may have limited generalizability to populations in other locations. Additionally, study participants may have been a selected sample of people who had survived to middle or old age without developing hypertension, the investigators acknowledged.

Another limitation was the reliance on self-reported data on discrimination.

Nevertheless, there are plausible mechanisms by which racial discrimination may lead to high BP.

“Discrimination may directly impact hypertension via the stress pathway, activating the sympathetic nervous system and hypothalamic-pituitary-adrenal axis. Discrimination may also lead to the development of hypertension through unhealthy behaviors, such as unhealthy eating or sedentary lifestyles, that may serve as a coping mechanism for the stress arising from discrimination,” according to Forde and colleagues.