_PUBLIC HEALTH Discrimination

_The Blood Boils

A lifetime of discrimination is associated with a greater risk of high blood pressure among African Americans, statistics show.

_Ana V. Diez Roux

Diez Roux is dean and distinguished University professor of Epidemiology in the Dornsife School of Public Health and director of the Drexel Urban Health Collaborative.

African Americans who report high levels of unfair treatment throughout their lives were more likely, even when adjusting for other risk factors, to have high blood pressure later in life according to a study from the Urban Health Collaborative at Drexel’s Dornsife School of Public Health.

The researchers — including lead author Allana T. Forde, who was a postdoctoral research fellow at the Urban Health Collaborative, and senior author and Urban Health Collaborative Director Ana Diez Roux, dean and distinguished professor of epidemiology at Dornsife School of Public Health — said the study could have implications for treating African American patients.

The authors used survey responses from African American adults living in Jackson, Mississippi, who participated in the Jackson Heart study (the largest investigation of cardiovascular disease in African Americans) and who did not have high blood pressure at the start of the study. Participants were defined as having hypertension if they were taking antihypertensive medication or had a systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg at follow-up visits.

Participants completed a baseline visit between 2000 and 2004 and two follow-up visits — one between 2005 and 2008 and the other between 2009 and 2013. At the time of the baseline visit, patients reported previous experiences of lifetime discrimination via survey. The researchers counted instances of lifetime discrimination within nine domains — such as in school/training, getting a job or housing, at work, etc. — in which unfair treatment was reported.

The authors found that individuals reporting medium levels (in one to two domains) and high levels of lifetime discrimination (in three to nine domains) had a 49 percent and 34 percent increased risk for hypertension compared to those who reported low levels of lifetime discrimination (zero domains), respectively, after adjusting for gender, age, socioeconomic status and other high blood pressure risk factors.