Discrimination, positive reappraisal, and hypertension among older Black adults

Black Americans have the highest rates of hypertension worldwide, yet the social and psychological mechanisms driving this disparity in older adulthood are not well established. Discrimination is theorized as a salient chronic stressor with implications for cardiovascular health, though findings linking discrimination to hypertension remain mixed. This study examined the role of positive reappraisal, a coping strategy, as a moderator of the association between discrimination and hypertension among older Black adults.

Data were drawn from the Nashville Stress and Health Study, a population-based sample in Davidson County, TN. Analyses focused on 273 Black respondents aged 50 and older. Modified Poisson regression models with robust standard errors were used to estimate direct associations between discrimination and positive reappraisal with physician-diagnosed hypertension, adjusting for sociodemographic covariates. We then included a discrimination × positive reappraisal interaction to this model.

Greater discrimination was associated with lower hypertension risk (RR = 0.89, 95% CI: 0.79-0.99). Positive reappraisal was not directly associated with hypertension, but the discrimination x positive reappraisal interaction was significant (RR = 1.07, 95% CI: 1.02-1.12), indicating that the association between discrimination and hypertension varied by levels of positive reappraisal.

Findings highlight the complex, context-dependent ways that older Black adults cope with racism-related stress. While positive reappraisal may buffer hypertension risk when discrimination is low, alternative strategies may be more protective when discrimination is high. These results underscore the need for culturally grounded interventions that address both exposure and coping in promoting cardiovascular health equity.