Cross-Sectional Association between Perceived Discrimination and Hypertension in African-American Men and Women: The Pitt County Study

Abstract

Few studies have examined the impact of the frequency of discrimination on hypertension risk. The authors assessed the cross-sectional associations between frequency of perceived racial and nonracial discrimination and hypertension among 1,110 middle-aged African-American men (n = 393) and women (n = 717) participating in the 2001 follow-up of the Pitt County Study (Pitt County, North Carolina). Odds ratios were estimated using gender-specific unconditional weighted logistic regression with adjustment for relevant confounders and the frequency of discrimination. More than half of the men (57%) and women (55%) were hypertensive. The prevalences of perceived racial discrimination, nonracial discrimination, and no discrimination were 57%, 29%, and 13%, respectively, in men and 42%, 43%, and 15%, respectively, in women. Women recounting frequent nonracial discrimination versus those reporting no exposure to discrimination had the highest odds of hypertension (adjusted odds ratio = 2.34, 95% confidence interval: 1.09, 5.02). A nonsignificant inverse odds ratio was evident in men who perceived frequent exposure to racial or nonracial discrimination in comparison with no exposure. A similar association was observed for women reporting perceived racial discrimination. These results indicate that the type and frequency of discrimination perceived by African-American men and women may differentially affect their risk of hypertension.

Perceived Discrimination and Incident Cardiovascular Events

“…Discrimination has been associated with more depressive symptoms (34), poorer mental health (4-6, 17), poorer sleep (35,36), increased adiposity (12)(13)(14)37), higher blood pressure (9)(10)(11), inflammatory biomarkers (15,16), and subclinical CVD (7,8). However, studies of discrimination and CVD risk factors are not unequivocal (2,17).…”

“…Few studies examining discrimination and CVD risk factors have clearly distinguished between race-based and nonracial discrimination. Studies that also evaluated racial/ethnic discrimination and CVD risk factors have generally not shown a stronger relationship for racial/ethnic discrimination than for overall perceptions of discrimination (7)(8)(9). Notably, no prior studies have investigated perceived discrimination or racial/ethnic discrimination in relation to incident CVD.…”

“…Experiences of ethnic discrimination and racism have long been considered to contribute to racial/ethnic disparities in CVD rates (2), but evidence for this is scarce. As several reviews have highlighted (3)(4)(5)(6), much of the extant literature on perceived discrimination and racism has focused on mental health consequences; more recently, studies have linked discrimination to physical health outcomes, including several indicators of cardiovascular health and functioning, such as higher prevalence of carotid artery atherosclerosis and coronary artery calcification, higher blood pressure, greater visceral fat and central adiposity, and higher levels of C-reactive protein and E-selectin (7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Management of High Blood Pressure in Blacks

“…[61][62][63] High levels of stress, being worried about HTN, experiencing adverse effects of antihypertensive medication, older age, self-reported medication nonadherence, and a HTN diagnosis Ͼ5 years were linked previously to the racial/ethnic disparity in BP control (lesser control in blacks). 61 The lesser BP control in blacks, however, does not appear to be related to not taking HTN seriously.…”

Stress Reduction in the Secondary Prevention of Cardiovascular Disease

“…[9][10][11] The disparity in CVD in blacks may be related to disproportionate levels of psychosocial and environmental stress. [12][13][14][15][16] Randomized, controlled trials of stress reduction using the Transcendental Meditation (TM) program have reported decreases in CVD risk factors, surrogate end points, and mortality in blacks and the general population. [17][18][19][20][21][22][23][24] The overall objective of this trial was to evaluate the effects of practice of the TM program in the secondary prevention of CVD in blacks.…”