Can the Experience of Discrimination Increase Hypertension Risk?

New insights from the Jackson Heart Study link lifetime discrimination and risk for hypertension in African-Americans.

In the U.S., Black people bear a greater burden of hypertension than any other racial or ethnic group. Investigators hypothesized that beyond traditional risk factors, the experience of discrimination contributes to higher hypertension prevalence and tested the hypothesis by analyzing data on 1845 African-American participants without baseline hypertension from the Jackson Heart Study, the longitudinal investigation of genetic and environmental risk factors associated with the disproportionate burden of cardiovascular disease in African-Americans.

Experience of discrimination was measured at visit 1 by two validated scales measuring lifetime and everyday discrimination. Of the [participants], 954 (52%) developed hypertension during follow-up. After adjustment for traditional cardiovascular risk and socioeconomic factors such as education, income, and occupation, individuals who reported medium-to-high levels of lifetime discrimination were more likely to develop hypertension than participants reporting low discrimination levels. No association was found between everyday discrimination and incident hypertension. In sex-stratified analyses, the association between lifetime discrimination and incident hypertension was observed only in women.

COMMENT

These study results suggest that discrimination might be an important contributor to the glaring disparities in hypertension experienced by African-American women. Discrimination was measured with validated survey instruments, but only at one point in time; however, it is likely that discrimination experiences are dynamic and thus incompletely captured cross-sectionally. More work is needed to see how interventions to combat discrimination affect cardiovascular risk in African-American communities.

Fatima Rodriguez, MD, MPH, FACC, FAHA reviewing Forde AT et al. Hypertension 2020 Jul 1

CITATION(S):

Forde AT et al. Discrimination and hypertension risk among African Americans in the Jackson Heart Study. Hypertension 2020 Jul 1; [e-pub].

[PubMed® abstract]