Link between Racism and High Blood Pressure

The health condition affects people of all races, but Black Americans are significantly more likely to experience high blood pressure. In fact, they're nearly 50 percent more likely to have hypertension than their white peers, according to the National Center for Health Statistics.

But before we take a closer look at the connection between racism and high blood pressure, let's clarify what blood pressure actually is: a measure of the pressure in your arteries as blood circulates.

Left untreated, high blood pressure increases a person's risk for heart attack, stroke and other serious and potentially fatal health conditions, per the AHA.

"Stress from real and perceived discrimination in daily life from structural racism" may be a driving factor behind high blood pressure in Black people, also noting that past research has shown that high levels of stress increase the risk of heart disease.

Study examined perceptions of varying types of discrimination among Black Americans, concluding that lifetime discrimination may increase their risk of high blood pressure.0

In other words, a single incident of discrimination may raise your blood pressure for a moment, but not necessarily keep it elevated.

In contrast, lifetime discrimination may better reflect the effects of cumulative exposure to bias over the years, and therefore may be more likely to be detected in higher blood pressure measurements over multiple doctor visits.

Subject to racism is a psychological stress

Stress causes the release of hormones like cortisol, adrenaline and others that result in arteries clamping down and the heart speeding up. These processes cause a transient elevation of blood pressure." But after "exposure to this psychological stressor for most hours of the day, chronic hypertension could develop," he says.

Indeed, it's nearly impossible to untangle the influence of diet, obesity, activity, environment and socioeconomic status from discrimination in the study's results.

"Racism is more structural, and I think in a way explains the more complex interaction between the environment [and the person], whereas [perceived] discrimination is what a person feels about the environment," he says. (Neither Dr. Ferdinand nor Dr. Capers was involved in the ​Hypertension​ study.)

That more subtle effect is captured in a popular concept in the study of racial health disparities known as weathering.

Weathering means like a constant exposure and a wearing down, The idea is that constant stress creates this wearing down that happens at a physiological level and it leads to chronic disease. Weathering proposes that the health of Black people in America is subject to early deterioration as a consequence of social exclusion and the chronic stress it causes, independent of the effects of poverty. The regular release of stress hormones such as cortisol or immune responses that lead to inflammation can lead to chronic disease, worsen it or even raise the risk of obesity.

Chronic stress resulting from perceived racism can also affect the way your heart rate reacts, says Anuj Shah, MD, an interventional cardiologist in Irvington, New Jersey. "It impacts something called heart rate variability, which relates to your heart's ability to go in and out of the flight-or-fight response." Heart rate variability is a biomarker that measures the time between heartbeats. If your system is in fight-or-flight mode, the variation in time between heartbeats will be low, Dr. Shah explains. Very poor heart rate variability can be a sign of chronic stress, he says, and people with low heart rate variability are more likely to have high blood pressure and worse cardiovascular health in general, he adds. Lifetime discrimination, threats associated with discrimination and being physically harassed in a discriminatory manner were associated with lower heart rate variability in a January 2018 ​Cultural Diversity and Ethnic Minority Psychology​ study involving 103 college students who identified as African American

Socioeconomic disadvantage plays a key role in the quality of health care that Black people receive, Dr. Shah says. The Black poverty rate is more than twice that of white people, accordias — can be so deeply embedded that they persist without anyone intending to discriminate."

These patterns result in factors like unstable housing, poverty, unsafe neighborhoods or substandard education, which are linked with higher rates of high blood pressure, according to the Centers for Disease Control and Prevention (CDC).

A diet high in salt, fried food, fat, bread and sweetened beverages is an important risk factor for hypertension in some Black people.

"Decreasing sodium intake to less than 2,300 milligrams a day is extremely important to help control blood pressure," Dr. Ferdinand says, yet the AHA reports that the average American adult takes in more than 3,400 milligrams per day.

Black adults are also more likely to be salt-sensitive, meaning the effects of a high-salt diet are more dramatic on their risk of high blood pressure. Salt-sensitivity has been linked to low levels of the enzyme renin, and Black people are more likely than their white counterparts to have low renin.​

Certain blood pressure medications block a hormone relating to the RAA system. When these medications are used alone, Black patients are, on average, less responsive than white patients, which may be because of the link to lower renin levels, according to a May 2018 review of studies in the Annals of Pharmacotherapy​.​

However, though he still recommends limiting sodium intake, Dr. Ferdinand says there isn't universal agreement on such findings. More research is needed on the effects of diet and the enzyme renin when it comes to Black Americans' risk of hypertension.

It shouldn't fall to Black people to fix the systemic racism that contributes to unequal health. There are steps that all individuals, policymakers and health care systems can take to help address the issue.

Health care systems and policymakers must take socioeconomic and environmental inequities into account, Dr. Capers says. "Treat racism as the public health problem that it is, and work to dismantle racism in policing, school systems, banking systems, etc."

People of all races should continue speaking out against racism and raising awareness of the public health concerns of injustice. Consider donating time and/or money to local organizations that are actively working to combat health inequities, such as:

• Therapy for Black Men
• The Loveland Foundation
• Black Women's Health Imperative
• Live Chair
• Freedge
• Diversify Dietetics
• Fit Pros Black Alliance
• Fit for Us

Black patients can advocate for optimal health care by:

• Seeking out care providers you feel comfortable with
• Preparing questions beforehand and asking plenty during an appointment
• Speaking up if you feel you're receiving subpar care

Dr. Capers' advice to Black people who want to lower their own risk for hypertension or manage high blood pressure is to control what you can.

"Eat healthy — more fruits and vegetables, less fried foods and high-calorie, high-salt foods. Try to maintain a healthy body weight; exercise 30 minutes a day in at least a brisk walk; learn relaxation techniques; nurture loving relationships with your family and friends; lean on your faith. All of these things can help reduce elevated blood pressure or stress."