Trauma of Racism Fuels High Blood Pressure Among Black Americans: Study

Cardiologist Dr. Willie Lawrence remains haunted by the memory of police shooting his best friend during a 1966 race riot in Cleveland.

“I saw my best friend shot in the back and the leg by police. I saw his sister shot five times. I witnessed all that, and that impacted me for the rest of my life,” said Lawrence, chief of cardiology at HCA Midwest Health’s Research Medical Center in Kansas City, Mo.

“I’d say I’m as afraid of police as anybody you’d ever come across, and that’s a stressor,” added Lawrence, who is Black.

The lasting echoes of that trauma left Lawrence not at all surprised by a new study linking racism in the United States to an elevated risk of high blood pressure among Black Americans.

Blacks who endure life-altering instances of discrimination are a third to a half more likely to develop high blood pressure than those who haven’t been similarly traumatized, researchers report in the July 1 issue of the journal Hypertension.

These results “may explain a lot of the racial differences between people’s health outcomes, and why African Americans are disproportionately impacted by hypertension,” said lead author Allana Forde, a postdoctoral research fellow at Drexel University’s Urban Health Collaborative in Philadelphia.

“Discrimination is bad for your health,” Forde said. “Discrimination is measurable and will impact your health in a negative way.”

Lawrence agreed, putting it even more bluntly.

“Racism is a public health problem. We have to first of all recognize that and understand that,” Lawrence said. “It’s killing African Americans in ways that this paper begins to tease out.

“It’s not the sudden death of strangulation,” Lawrence said. “It’s the slow death of discrimination.”

High blood pressure is more common in Black adults than any other ethnic group, affecting about 54% of Black Americans, according to the U.S. Centers for Disease Control and Prevention. Blacks also are more likely to develop high blood pressure at an earlier age.

This new study tracked the heart health of 1,845 Blacks enrolled in the Jackson Heart Study, a long-term investigation of heart disease among Black Americans living in Mississippi.

Forde and her colleagues asked participants whether they’d experienced major life-changing events tied to racism — difficulty getting a job or advancing a career, finding a place to live, obtaining a bank loan, or receiving medical care.

The participants did not have high blood pressure when they entered the study in the early 2000s. Doctors tracked their health for about a decade, during which a little more than half of participants developed high blood pressure.

Blacks who reported medium levels of lifetime discrimination had a 49% increased risk of high blood pressure after accounting for other risk factors, the researchers found. Those with high levels of lifetime discrimination were 34% more likely to develop high blood pressure.

The stress associated with racism probably is a major factor in this increased risk, Forde and Lawrence speculated.

“It’s the cumulative exposure to stress over someone’s life course that eventually leads to wear and tear on the body, the physiological changes that occur that can lead to hypertension,” Forde said.

Coping with such stress also could lead Blacks to make lifestyle choices that are bad for their heart health, including eating unhealthy foods or drinking too much alcohol, Forde added.

In fact, the effect of racism on Black Americans’ heart health might be even greater than reported in this study, since the results accounted for blood pressure risk factors that could themselves be heightened by discrimination, the researchers noted.

The study “gives support to what we know about the disease in general, what we know about your zip code compared to your genetic code, the social determinants of health,” Lawrence said.

It also demonstrates the importance of the Black Lives Matter movement and other efforts aimed at ending racism and discrimination in the United States, Lawrence said.

“We have to redefine policing, because that’s a big source of racism and stress, especially for African Americans,” Lawrence said. “Ending discrimination is one of the things that is an altruistic goal for which we all as a culture have to strive. There’s sudden death and there’s slow death. Hypertension represents slow death.”

More information

The American Heart Association has more about high blood pressure and African Americans.