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PerceivedDiscrimination andHypertension Among African Americans in the Jackson Heart Study

Previous research reported an association between perceived discrimination and health outcomes. In particular, hypertension (which is higher among African Americans than Whites) was linked to discrimination, although findings were not always consistent. Although traditional biobehavioral risk factors might explain some of the African American---White disparity in hypertension, differences in exposure to discrimination by race might also contribute. African Americans’ exposure to discrimination could influence their risk for hypertension through various mechanisms. These include negative coping behaviors, such as unhealthy eating, sedentary lifestyles, and tobacco and alcohol intake. The experience of discrimination could also cause emotional distress, which can trigger physiological responses involving the hypothalamic---pituitary---adrenal axis and the sympathetic---parasympathetic systems, which play an important role in the pathophysiology of hypertension. Although exceptions exist, most previous studies of perceived discrimination and hypertension in African Americans employed relatively small samples and focused on a single measure of discrimination. The Jackson Heart Study (JHS), the largest prospective study of cardiovascular disease in African Americans, offered a unique opportunity to examine the association between multiple dimensions of discrimination (everyday, lifetime, burden, and stress from discrimination) and hypertension in a large sample of African Americans. The measures of various dimensions of discrimination obtained in JHS included everyday discrimination, which captured daily hassles associated with discrimination, lifetime discrimination, which captured acute and observable experiences similar to life events in the stress literature, and perceived burden and stress from discrimination. Because discrimination was conceptualized as a multifactorial construct, the inclusion of multiple measures might be necessary to accurately capture the impact of discrimination on health. We hypothesized that perceived discrimination would be positively associated with hypertension, and that health behaviors would partially mediate the association. Because previous work documented associations of discrimination with hypertension among women, but not men, and because of differences in hypertension prevalence by gender, we tested for effect modification by gender.