Discrimination and hypertension risk among African Americans in the Jackson Heart Study

Abstract

African Americans have a higher risk of hypertension compared with other racial or ethnic groups in the United States. One possible explanation for this disparity is discrimination. Few studies have examined the association between discrimination and incidence of hypertension. We examined whether everyday discrimination, lifetime discrimination, and stress from discrimination were associated with incident hypertension and whether these associations differed by gender, age, discrimination attribution, and coping responses to discrimination among African Americans in the Jackson Heart Study. Discrimination was self-reported by 1845 African Americans aged 21 to 85 years without hypertension at baseline (2000-2004). Participants completed 2 follow-up study visits from 2005 to 2008 and 2009 to 2013. We used Cox proportional hazards regression to estimate associations of discrimination with incident hypertension. Overall, 52% (n=954) of the participants developed hypertension over the follow-up period. After adjustment for age, gender, socioeconomic status and hypertension risk factors, medium versus low levels of lifetime discrimination (hazard ratio, 1.49 [95% CI, 1.18-1.89]), and high versus low levels of lifetime discrimination (hazard ratio, 1.34 [95% CI, 1.07-1.68]) were associated with a higher incidence of hypertension. No statistically significant interactions with gender, age, attribution, or coping were present. Higher stress from lifetime discrimination was associated with higher hypertension risk after adjustment for demographics (hazard ratio for high versus low, 1.19 [95% CI, 1.01-1.40]), but the association was attenuated after adjustment for hypertension risk factors (hazard ratio, 1.14 [95% CI, 0.97-1.35]). Lifetime discrimination may increase the risk of hypertension in African Americans.