Pressão arterial e discriminação interpessoal: revisão sistemática de estudos epidemiológicos

Abstract

The relationship between blood pressure and discrimination has been recently investigated, and there are conflicting debates in literature devoted to the topic.The objective of this study was to update previous literature reviews on discrimination and blood pressure.A bibliographic search was conducted in PubMed between January/2000 and December/2010, including epidemiological studies, assessing the relationship between interpersonal discrimination and blood pressure/hypertension.The 22 studies included originated from the United States; 96% of them used the cross-sectional design with convenience sample, comprising, in 59% of the studies, exclusively Black participants. The Everyday Discrimination Scale and the Perceived Racism Scale were the most frequently used instruments, emphasizing lifetime or chronic/everyday racial/ethnic discrimination. In the 22 studies assessed, the association between discrimination and blood pressure/ hypertension was assessed 50 times. Twenty results (40%) showed no association between them, and only 15 (30%) revealed global positive associations, of which 67% were statistically significant. Eight negative associations were also observed, suggesting that higher exposure to discrimination would be associated with lower blood pressure/hypertension.The studies did not consistently support the hypothesis that discrimination is associated with higher blood pressure. These findings can be partially attributed to the limitations of the studies, especially those related to the measurement of discrimination and of factors that might modify its association with outcomes. To establish discrimination as an epidemiological risk factor, more rigorous methodological strategies should be used, and the theoretical frameworks that postulate causal relationships between discrimination and blood pressure should be reviewed.

Revisão sistemática dos estudos epidemiológicos sobre discriminação interpessoal e saúde mental

“…A maior parte das relações examinadas confirma a expectativa dos pesquisadores, sendo estatisticamente significante. Isso se dá de modo diferente dos resultados de estudos com desfechos de saúde física como, por exemplo, pressão arterial, que não apresentam resultados tão consistentes 61 . A variedade de grupos que apresentou associações condicionais (por exemplo, homens, mulheres, brancos, negros) demonstra inexistência de um padrão claro.…”

Discrimination and Health Inequities

“…[2012] (196) The studies in this review show that racism is associated with differential health outcomes and can adversely affect psychological and physiological functioning. Furthermore, they provide data to show that racism is associated with negative biopsychosocial sequelae that may contribute to health disparities, and different exposure to it contributes to variability in health outcomes within groups.…”

Examining the association between perceived discrimination and heart rate variability in African Americans.

“…A number of studies have focused on the association between discrimination and BP, or hypertension (for reviews see Brondolo, Love, Pencille, Schoenthaler, & Ogedegbe, 2011; Brondolo, Rieppi, Kelly, & Gerin, 2003; Couto, Goto, & Bastos, 2012; Cuffee, Hargraves, & Allison, 2012; Dolezsar, McGrath, Herzig, & Miller, 2014; Harrell, Hall, & Taliaferro, 2003; Paradies, 2006; Williams & Neighbors, 2001); however, there is an ongoing debate regarding the consistency of this relationship (e.g., Brondolo et al, 2011; Couto et al, 2012; Dolezsar et al, 2014; Paradies, 2006). For instance, in a recent meta-analysis of perceived racial discrimination and hypertension/BP studies spanning a 30-year period, Dolezsar and colleagues (2014) found that perceived discrimination was consistently associated with hypertensive status; however, the size of this effect was relatively small (Fisher’s z = .05) and was moderated by such factors as Black race/ethnicity, male gender, older age and educational status.…”