Racism, discrimination and hypertension: evidence and needed research

This paper reviews the available scientific evidence that relates racism to the elevated rates of hypertension for African Americans. Societal racism can indirectly affect the risk of hypertension by limiting socioeconomic opportunities and mobility for African Americans. Racism can also affect hypertension by 1) restricting access to desirable goods and services in society, including medical care; and 2) creating a stigma of inferiority and experiences of discrimination. This paper evaluates the available evidence for perceptions of discrimination. African Americans frequently experience discrimination and these experiences are perceived as stressful. Several lines of evidence suggest that stressors are positively related to hypertension risk. Exposure to racial stressors under laboratory conditions reliably predicts cardiovascular reactivity and such responses have been associated with longer-term cardiovascular risk. Few population-based studies have examined the association between exposure to racial discrimination and hypertension, and the findings, though suggestive of a positive association between racial bias and blood pressure, are neither consistent nor clear. However, the existing literature identifies important new directions for the comprehensive measurement of discrimination and the design of rigorous empirical studies that can evaluate theoretically derived ideas about the association between discrimination and hypertension.