Black patients preoccupied with racial concerns have higher
blood pressure than those who aren't, according to results of new Johns
Hopkins-led research. The findings suggest that heightened race consciousness
could at least in part account for the disproportionately high rate of hypertension
in black people.
"A preoccupation with race among blacks leads to
hyper-vigilance, a heightened awareness of their stigmatised status in society
and a feeling that they need to watch their backs constantly," says Lisa
A. Cooper, M.D., M.P.H., a professor in the Division of General Internal
Medicine at the Johns Hopkins University School of Medicine and senior author
of the study described online in the American
Journal of Hypertension.
"Specifically 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 health care 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."
Cooper says the issue of such hyper-vigilance and race
consciousness has drawn more public attention in the wake of the killing of
Trayvon Martin, an unarmed black teenager, in Florida. Her own African-American
son, she says, is very aware of his surroundings.
"It's stressful for him to walk around thinking at
anytime someone might think he's doing something wrong just because of his
race," she says. "That's just something he lives with. If you don't
live with it, maybe it's hard to understand it. It's something people often
don't want to talk about."
How the research was
As part of ongoing research into doctor-patient
relationships and racial disparities, Cooper and her colleagues surveyed 266
patients in urban health clinics in Baltimore between September 2003 and August
Sixty-two percent of the patients were black. To test for
race consciousness, they used the 2002 Behavioral Risk Factor Surveillance
System "Reactions to Race" module developed by the US Centers for
Disease Control and Prevention. Patients — both black and white — were asked
how often they thought about their race.
Two categories were created: Those who said they ever think
about their race and those who said they never do. Half of the black patients
responded that they "ever" think about it, and one in five white
patients said they did.
When blood pressures were measured, being a race-conscious
black patient was associated with significantly higher diastolic blood pressure
(roughly five millimetres of mercury) and somewhat higher systolic blood
pressure (some four millimetres of mercury) than black patients who were not
preoccupied with race.
There was no effect on blood pressure in race conscious
white patients. Systolic blood pressure, the top number in a blood pressure
reading, measures the force that pressure from the beating heart places on the
arteries moving blood to the rest of the body, while diastolic blood pressure,
the bottom number, indicates the pressure in the arteries when the heart rests
Cooper, director of the Johns Hopkins Center to Eliminate
Cardiovascular Health Disparities, says it is well known that chronic stress
can increase blood pressure. Similarly, she says tasks that require active
coping efforts may increase heart rate and systolic blood pressure, while tasks
that require quiet attentiveness and vigilance may lead to decreased cardiac
output as well as increased diastolic blood pressure.
What the study found
In addition to the link between race consciousness and blood
pressure, Cooper's team found that whites who were race conscious were more
likely to feel respected in the doctor-patient relationship than whites who
were not concerned with race, though they were less likely to take their blood
pressure medication as prescribed.
"Given the socially dominant status of whites in the
United States, higher levels of race consciousness could reflect greater
awareness of white privilege," the authors note in the study.
"Another explanation, particularly among whites who reside in areas with a
high black population, is that race consciousness reflects a heightened fear of
victimization, an anxiety-provoking stressor. Scholars of critical race theory
are still debating whether race consciousness enhances or adversely effects the
health of whites."
Cooper notes that it can be stressful for black people to go
shopping in a store and feel they are being watched extra closely. Equally
stressful, she says, is for example, waiting a long time to be served at a
restaurant, and being ignored, possibly because of one's race.
More research is needed to understand the biological
consequences of race consciousness, including those related to stress, she
adds, with a goal of developing interventions to help people effectively cope
with environmental stressors.
"We need to help people of all races cope with
race-related stress in a healthier way," she says.