FRIDAY, Aug. 16, 2013 (MedPage Today) — African Americans with a hypervigilant sense of being black may have an increased risk of hypertension, a cross-sectional analysis found.
Among 266 patients in urban clinics in Baltimore who were surveyed, being a race-conscious black patient was associated with significantly higher diastolic blood pressure (roughly 5 mmHg) and a tendency toward a higher systolic blood pressure (about 4 mmHg) than black patients who were not preoccupied with race.
There was no similar effect on race-conscious whites, reported Lisa A. Cooper, MD, MPH, director of the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities in Baltimore, and colleagues in the American Journal of Hypertension.
The findings suggest that heightened race consciousness could at least in part account for the disproportionately high rate of hypertension in black Americans -- the highest prevalence of any group in the U.S. and one of the highest rates in the world, researchers said.
"A preoccupation with race among blacks leads to hypervigilance, a heightened awareness of their stigmatized status in society, and a feeling that they need to watch their backs constantly," Cooper said in a statement.
"African Americans have higher blood pressure and it has been difficult to explain why this is true. It doesn't appear to be genetic, and while things like diet, exercise, and reduced access to healthcare may contribute, we think that a tense social environment, the sense of being treated differently because of your race, could also possibly explain some of what's behind the higher rates," she added.
Studies have suggested that risk factors rather than race play a more important role in stroke related to hypertension and that salt sensitivity in blacks which leads to hypertension has a genetic origin.
The 2010 updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks lowered the minimum target blood pressure level for the lowest-risk blacks (less than 135/85 mmHg), emphasized effective multidrug regimens, and de-emphasized monotherapy.
To test for race consciousness, Cooper and colleagues used the 2002 Behavioral Risk Factor Surveillance System "Reactions to Race" module developed by the CDC. Patients -- both black and white -- were asked how often they thought about their race.
A total of 62% of the 266 participants were black, and 65% were women. Nearly three-quarters had incomes less than $35,000 per year and more than 90% had either health insurance or a prescription plan. The mean age was 61.
Nearly half of the African-American patients responded that they had "ever" thought about race compared with 20% of whites.
The mean systolic and diastolic blood pressure of blacks who ever (n=82) and never (n=84) thought about race were:
- 138.8 mmHg (range 134-143.5) versus 134.7 mmHg (range 131.4-137.9) P=0.13
- 79.4 mmHg (range 76.9-81.9) versus 74.5 (range 72.2-76.9) P=0.004
The same measurements for whites (ever and never) were:
- 139.7 (range 125.1-134.3) versus 132.7 (range 127.3-138.1) P=0.47
- 72.3 (range 68.6-76.1) versus 73.4 (range 70.6-76.2) P=0.64
"Given the socially dominant status of whites in the U.S., higher levels of race consciousness could reflect greater awareness of white privilege," the authors noted in the study.
"Scholars of critical race theory are still debating whether race consciousness enhances or adversely affects the health of whites," they added.
Being race conscious was associated with having a nonsignificant lower adherence to medication in both blacks and whites compared with those who were not race conscious.
Researchers found no difference in the physician-patient relationship regarding trust and respect among blacks and whites who were and were not race conscious.
And more blacks and whites who were employed full time tended to be race conscious than those employed part time, retired, or disabled.
Limitations of the study, according to the authors, included having only one clinical encounter with each patient, small sample size, potential recall bias in self-reporting, and potentially positively skewed physician-patient relationships because each was well known to the other.
Last Updated: 8/16/2013