Researchers are drawing a connection between discrimination and sky-high rates of hypertension. Here’s what they want everyone to know.

By Ayana Byrd
November 16, 2020
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Esther Celamy-Williams didn’t just assume she lived a healthy lifestyle. As a licensed practical nurse, she was trained to know she did. So when the Orlando, Florida, mom learned her headaches and bouts of dizziness were caused by high blood pressure, she was shocked: “I didn’t eat a lot of salt—nothing that would have led me to think that’s what it was,” says Celamy-Williams, who was 27 at the time and is now 42. “I thought I was too young.”

But there were two factors beyond Celamy-Williams control that put her at risk for hypertension: her race and her gender. African American women are 60 percent more likely to have high blood pressure than non-Hispanic white women, according to the U.S. Department of Health and Human Services Office of Minority Health. They are also more likely to have hypertension than Black men—which means Black women are one of the highest risk groups for high blood pressure in the nation.

The Problem

“Hypertension is highly prevalent in African Americans—and is a major cause of heart disease, renal disease, heart attacks, and strokes,” says Allana T. Forde, PhD, MPH, an investigator at the National Institutes of Health who focuses on racial disparities in health outcomes. More than 42 percent of Black adults in the U.S. have elevated blood pressure.

There are possible medical explanations for this statistic, including higher rates of obesity and diabetes among African Americans. Some scientists think that a gene may make Black people more susceptible to the effects of salt on blood pressure. 

Yet a growing body of research is starting to address the elephant in the room: African Americans may be at a higher risk for hypertension because discrimination can lead to chronic stress, and that can raise blood pressure.

Black women may be especially vulnerable to this health consequence. “Black women carry a higher allostatic load—which is a measure of the physiological impact of stress on the body—than Black men and white women,” says journalist Kenrya Rankin, coauthor of How We Fight White Supremacy. “Researchers attribute that large load to walking around with the combined weight of racism and sexism on our shoulders.”

Arline Geronimus, ScD, a professor of health behavior and health education at the University of Michigan School of Public Health in Ann Arbor, has developed an academic theory to explain this phenomenon. She has coined the term “weathering” to describe the way toxic stress—the kind caused by discrimination—leads to the premature deterioration of Black women’s health. And she points to weathering as a factor in the disproportionately high rates of hypertension, cardiovascular disease, maternal mortality, and other negative health outcomes in Black women.

The causes of weathering are both subtle and overt. They can include microaggressions—daily slights, indignities, and “casually racist” comments—as well as the barrage of media images of unarmed Black people being killed by police. These types of stressors may have a cumulative impact, eroding health over time.

The Consequences

When Forde was a postdoctoral research fellow at the Urban Health Collaborative at Drexel University’s school of public health, in Philadelphia, she and a team of other researchers there investigated the link between discrimination and hypertension for a study published in July. They found that African Americans who had experienced moderate levels of discrimination over the course of their lives had an almost 50 percent increased risk of high blood pressure, compared with African Americans who had experienced low levels. Other research, published in the American Journal of Hypertension in 2018, has found that being vigilant as a coping strategy for racism was linked to higher odds of developing hypertension.

“Discrimination can directly impact hypertension, by activating the body’s sympathetic nervous system and hypothalamic-pituitary-adrenal axis, through what is referred to as the ‘stress pathway,’ ” says Forde. In other words, it triggers the fight-or-flight response, and the release of hormones that constrict blood vessels, raising blood pressure.

The Prescription

After the researchers from Drexel’s Urban Health Collaborative analyzed the results of their study, they concluded that to save the lives of African Americans doctors must broaden their thinking: “Our findings suggest that health care professionals should recognize societal factors, such as discrimination—and not just clinical factors—in order to understand why African Americans have a higher risk of hypertension than whites,” says Forde.

A good first step for providers: Actively strive to be anti-racist, says Rankin. “They need to ask themselves some tough questions, and then actually sit with the answers,” she explains. “Questions like: ‘What harmful lessons did I learn in medical school that need to be unlearned?’ ‘How does structural racism impact my patients and the way I interact with them?’ ”

This will make them better doctors but will also help chip away at inequality on a societal level. “Studies have found that bias, stereotyping, and prejudice contribute to health inequities, influencing clinical decision-making and patient care for [people] in minoritized communities,” says Aletha Maybank, MD, MPH, chief health equity officer of the American Medical Association.

Another thing medical professionals can do is foster relationships with organizations focused on Black women’s health, says Rankin. “Some provide free health care. Some employ community health advisers, who live in the communities they serve and attend doctor’s appointments with Black patients to advocate for them in the exam room. Others run ground-level education campaigns to help connect people with quality care.” For example, a program with the Mayo Clinic in Rochester, Minnesota, called FAITH!—or Fostering African-American Improvement in Total Health—partners with Black churches to promote heart health across the state. 

By not minimizing the effects of discrimination on their patients, doctors and other health experts can help lower rates of hypertension for Black women. After all: “Being Black is not a risk factor for poor health; racism is,” says Dr. Maybank. “Racism continues to make Black women more vulnerable to illness.” As awareness grows, health outcomes should improve, but it is a process that will take time.

Celamy-Williams, who has been on medication to control her blood pressure since her diagnosis, is now very conscious of the role discrimination can play in Black women’s health. “We are always tense,” she says. “We are always on heightened alert, always aware of our environment.” Over the years, Celamy-Williams has developed strategies to manage her own stress level. “I relax, no TV, prayer, just zone into my own world,”she says. “I’ve learned how to stop internalizing all the things going on around me.” 

This article originally appeared in the December 2020 issue of Health Magazine. Click here to subscribe today!

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