The Relationship Between Perceived Discrimination and Blood Pressure in Black Adults: A Narrative Review.

Abstract

Background: Cardiovascular disease is the leading cause of death in the United States, with disproportionately higher morbidity and mortality rates among Black people. Experiences of discrimination and racism constitute a public health crisis. Given the significant race- and ethnicity-related disparities in cardiovascular health, it's essential to understand the mechanisms by which these disparities occur.

Purpose: The purpose of this review was to identify and synthesize the current literature on the relationship between perceived discrimination and its impact on blood pressure among Black adults.

Methods: A literature search was conducted to locate relevant research. To be included, articles had to report on quantitative studies that were conducted in the United States among Black adults, used discrimination as an independent variable, and used blood pressure or hypertension as an outcome variable. These articles also had to have been peer-reviewed and published in English between 2010 and 2021. Discrimination was categorized as everyday, lifetime, or both.

Results: Eleven studies met all criteria and were included for analysis. Eight of these studies reported an association between increased racial discrimination and higher blood pressure; moreover, of the eight studies that reported this finding, seven specified lifetime discrimination.

Conclusions: This narrative review found significant evidence supporting a positive association between perceived lifetime discrimination and blood pressure in Black adults. But the relationship isn't clearly understood, and future research should explore the underlying mechanisms and potential confounders. Priorities include more rigorous assessment of Black individuals' experiences with both lifetime and everyday discrimination and how these interact with confounders (such as stress), so that blood pressure control can be better achieved in this population. Specific areas for investigation include considering how we measure discrimination, the impact of provider bias and discrimination, and the impact of discrimination on medication adherence. This work is essential to developing the urgently needed, evidence-based interventions that will help to prevent racial and ethnic discrimination and mitigate its effects.