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The Relationship Between Perceived Discrimination and Blood Pressure in Black Adults: A Narrative Review
1Sandy Cayo is an assistant professor at the Yale University School of Nursing, Lawrence, NJ. Alison Colbert is a professor at the Duquesne University School of Nursing, Pittsburgh, PA. Contact author: Sandy Cayo, sandy.cayo@yale.edu . The authors have disclosed no potential conflicts of interest, financial or otherwise.
Insights
Experiences of lifetime discrimination are linked to higher blood pressure in Black adults. Further research is needed to understand the mechanisms and develop interventions to mitigate these cardiovascular health disparities.
Area of Science:
- Public Health
- Cardiovascular Health
- Health Disparities
Background:
- Cardiovascular disease (CVD) is a leading cause of death in the U.S.
- Black individuals experience disproportionately higher CVD morbidity and mortality rates.
- Racism and discrimination are public health crises contributing to these disparities.
Purpose of the Study:
- To review and synthesize existing literature on the association between perceived discrimination and blood pressure in Black adults.
- To identify the current state of research on this critical public health issue.
Main Methods:
- A literature search identified quantitative studies published between 2010 and 2021 in the U.S.
- Studies included Black adults, with discrimination as the independent variable and blood pressure/hypertension as the outcome.
- Discrimination was categorized as everyday, lifetime, or both.
Main Results:
- Eleven studies met the inclusion criteria.
- Eight studies found a significant association between increased racial discrimination and higher blood pressure.
- Seven of these studies specifically identified lifetime discrimination as a key factor.
Conclusions:
- Significant evidence supports a positive association between perceived lifetime discrimination and elevated blood pressure in Black adults.
- The precise mechanisms underlying this relationship require further investigation.
- Future research should focus on rigorous assessment of discrimination experiences and confounders to inform interventions for blood pressure control.
Background:
Cardiovascular disease is the leading cause of death in the United States, with disproportionately higher morbidity and mortality rates among Black people. Experiences of discrimination and racism constitute a public health crisis. Given the significant race- and ethnicity-related disparities in cardiovascular health, it's essential to understand the mechanisms by which these disparities occur.
Purpose:
The purpose of this review was to identify and synthesize the current literature on the relationship between perceived discrimination and its impact on blood pressure among Black adults.
Methods:
A literature search was conducted to locate relevant research. To be included, articles had to report on quantitative studies that were conducted in the United States among Black adults, used discrimination as an independent variable, and used blood pressure or hypertension as an outcome variable. These articles also had to have been peer-reviewed and published in English between 2010 and 2021. Discrimination was categorized as everyday, lifetime, or both.
Results:
Eleven studies met all criteria and were included for analysis. Eight of these studies reported an association between increased racial discrimination and higher blood pressure; moreover, of the eight studies that reported this finding, seven specified lifetime discrimination.
Conclusions:
This narrative review found significant evidence supporting a positive association between perceived lifetime discrimination and blood pressure in Black adults. But the relationship isn't clearly understood, and future research should explore the underlying mechanisms and potential confounders. Priorities include more rigorous assessment of Black individuals' experiences with both lifetime and everyday discrimination and how these interact with confounders (such as stress), so that blood pressure control can be better achieved in this population. Specific areas for investigation include considering how we measure discrimination, the impact of provider bias and discrimination, and the impact of discrimination on medication adherence. This work is essential to developing the urgently needed, evidence-based interventions that will help to prevent racial and ethnic discrimination and mitigate its effects.
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