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Blood Pressure, Stress, and the Social Environment: On Black-White Differences in Blood Pressure

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Charles Darwin

Denis Noble

JP Rushton

Richard Lynn

L:inda Gottfredson

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1800 words

Blood pressure (BP) is a physiological variable. Therefore since it is a physiological variable then it can be affected by environmental and social changes. How do racial differences come into play here, for instance? Since blacks face more (perceived) discrimination, then they should, on average, have higher BP levels than whites. This is what we find—but the effect is mostly seen in low-income blacks. How do psychosocial factors come into play here in the black-white BP gap?

BP is regulated by cardiac output, vascular resistance of blood flow, blood volume, arterial stiffness, and, of course, the individual’s emotional state which can decrease or increase BP. Neural mechanisms also exist which regulate BP (Chopra, Baby, and Jacob, 2011). Knowing how and why BP increases or decreases will have us better understand the social contexts of increased BP in low SES blacks.

BP is a complex physiological trait. It can go up and down due to what occurs in the immediate environment. Values of 120/80 mmHg are cited as ‘average’ values, but we have no idea what an ‘average’ BP is. Nevertheless—like most/all physiological variables—there is a wide range of what is considered ‘normal’. Due to the variance in human physiological systems, what is ‘normal’ for one individual is not ‘normal’ for another. Variation in BP (like, say, 120 SBP (systolic blood pressure) to 140 SBP) is ‘normal’. I believe even around 110 for SBP is within that range. For DPB (diastolic blood pressure) between 75 and 90 is within normal diurnal fluctuations due to activity/eating/etc (Taylor, Wilt, and Welch, 2011). BP, like testosterone, is one of those tricky variables to measure and so must be measured upon waking to see if there are any problems. So even for a trait like BP, there seems to be a ‘normal range’.

About 33 percent of blacks have hypertension (HTN) (Peters, Arojan, and Flack, 2006). Urban blacks are more likely to have higher BP levels than whites, but “At present, there is no complete explanation for these differences and further research is required” (Lindhorst et al, 2007). Low SES is correlated with higher levels of BP in black Americans—especially those with darker skin—but not Africans in Africa (Fuchs, 2011), suggesting that this is an American phenomenon that needs to be addressed. One good explanation, in my view, is the social environment. Physiological traits are extremely malleable due to the need to be able to ‘change gears’ in an instant, for instance to either fight or flight. Though, in our modernized world, these responses—mostly—have no need and so (due to our supposed civilized behavior), one’s BP rises due to social stress and other environmental factors and it is due to the urban environment.

What is the cause of high BP in blacks?

One explanation that has been given to explain higher rates of BP in blacks when compared to whites is discrimination. However, studies show mixed evidence on whether or not so-called discrimination raises BP (Couto, Goto, and Bastos, 2012). The same American effect (American blacks having higher BP than American whites) is seen even in the UK London area (Agyemang and Bhopal, 2003). This, yet again, is more evidence that the social environment drives these differences—again, regardless of whether or not any of the discrimination is real or imagined. Say most of it were imagined: it’d be irrelevant because the imagined discrimination leads to very real physiological outcomes in BP. 

The country of birth also has an effect on BP. In one study, it was noted that Africans had significantly higher BP when compared to Asians (which is identical/lower) and native French living in France (Bahous et al, 2015). Ethnic differences in BP increase due to similar sodium intake is lower than what is usually cited (Graudal and Jurgens, 2015). However, other authors have pointed out that basing conclusions off of observational studies have problems, like the estimation of sodium intake being inaccurate since it’s a one-time measure;  (Gunn et al, 2013; Cobb et al, 2014)

There is also evidence—along with pathways—that show how certain social activities work to lower stress and BP, including participation at church (Livingstone, Devine, and Moore, 1991). Black Americans can make other lifestyle changes in order to decrease BP, such as exercise and other lifestyle interventions. Redman, Baer, and Hicks state that “gene-environment interactions, job-related stress, racism, and other psychosocial factors to racial/ethnic disparities” need to be explored as causes for higher rates of HTN in blacks compared to whites. And with the knowledge of how all physiological systems work in terms of stress and other factors, should be explored as causes for this disparity.

Grim et al (1990) state that factors that influence high BP in blacks compared to whites are inherited and that is the major source of variation between these populations. However, the other mounting social/physiological evidence deserves an explanation; that is not inherited, and what we know about how our physiology responds to stress and discrimination—whether real or imagined—are extremely important and lead to extremely real, and important, outcomes in these populations. It is also argued that since blacks en route to America during the slave trade died from salt-depletive diseases, that blacks with a higher genetic propensity to absorb salt survived and this is why blacks have a higher propensity to absorb salt and are more ‘salt-sensitive’, which also could explain higher rates of HTN in American blacks compared to their cousins in Africa (Wilson and Grim, 1991). However, Curtin (1992) disputes this because “There is no evidence that diet or the resulting patterns of disease and demography among slaves in the American South were significantly different from those of other poor southerners”.

However, in regards to the social environment, Williams (1992) drives one of the best arguments I have encountered in this literature so far, stating that while genetic factors play a small part in regards to the BP gap between blacks and whites, social factors are arguably more important than genetic ones (and with our homeodynamic physiology, this does make sense). Dressler (1990) for instance, argues that skin color is a proxy for both social class and discrimination and these factors explain a large amount of the variation. Psychosocial variables can also explain heightened BP (Marmot, 1985Cuffee et al, 2014). Yan et al (2003) also note how “time urgency/impatience” and “hostility” “were associated with a dose-response increase in the long-term risk of hypertension.” Henry (1988) also argues that calcium, obesity and genetic factors cannot be the aetiology of HTN in blacks, while also proposing that high sodium intakes are due to psychosocial stress (Williams, 1992: 136).

Obesity also leads to hypertension (Re, 2009) while blacks are more likely to be obese than whites, however, black American men with more African ancestry are less likely to be obese (Klimentidis et al, 2016). This would imply that the greater amount of African ancestry in American blacks both protects against obesity and along with it HTN. Williams (1992) makes a convincing argument that environmental and social factors are the cause for the black-white BP gap. And while genetic factors are important, no doubt, environmental  and social factors are arguably more important to this debate.

Kulkarni et al (1998) show that increased stress leads to subsequent BP elevations which, over time, will lead to HTN. In a 2009 meta-analysis, Gasparin et al show how “individuals who had stronger responses to stressor tasks were 21% more likely to develop blood pressure increase when compared to those with less strong responses.”

Further, in support for the ‘perceived stress’ hypothesis in regards to blacks ‘perceiving’ stress and discrimination, “stress denial in combination with abdominal obesity, alcohol consumption, and smoking may be proxy for a high stress level” (Suter et al, 1997). Carroll et al (2001) also show how there are is “modest support for the hypothesis that heightened blood pressure reactions to mental stress contribute to the development of high blood pressure.Sparrenberger et al (2009) also did a systematic review of observational studies, finding that “Acute stress is probably not a risk factor for hypertension. Chronic stress and particularly the non-adaptive response to stress are more likely causes of sustained elevation of blood pressure.

Lastly, Langford (1981) shows that when SES is controlled for, the black-white BP disparity vanishes, implying that social and environmental—not genetic—factors are the cause for elevated HTN levels in black Americans. Sweet et al (2007) showed that for lighter-skinned blacks, as SES rose BP decreased while for darker-skinned blacks BP increased as SES did while implicating factors like ‘racism’ as the ultimate causes. This is solid evidence that both skin color and SES are predictors of higher prevalence of BP in black populations, and since other studies show that this is not noticed in higher class blacks, nor is this noticed in blacks in Africa, then the main causes of this disparity are social and environmental in nature.

(Non, Gravlee, and Mulligan, 2012). Their study suggests that educating black Americans on the dangers and preventative measures of high BP will reduce BP disparities between the races. This is in-line with Williams (1992) in that the social environment is the cause for the higher rates of BP. One hypothesis explored to explain why this effect with education was greater in blacks than whites was that BP-related factors, such as stress, poverty and racial discrimination (remember, even if no racial discrimination occurs, any so-called discrimination is in the eye of the beholder so that will contribute to a rise in physiologic variables) and maybe social isolation may be causes for this phenomenon. Future studies also must show how higher education causes lower BP, or if it only serves as other markers for the social environment. Nevertheless, this is an important study in our understanding of how and why the races differ in BP and it will go far to increase our understanding of this malady. This is a very convincing argument that education and not genetic ancestry cause disparities in BP between blacks and whites.

WebMD states that, of course, both environmental and genetic factors are at play in regards to black’s increased propensity for acquiring HTN. Fuchs (2011) also states that “They [environmental and behavioral factors] could act directly or by triggering mechanisms of blood pressure increase that are dormant in blacks living in Africa” and explain why black Americans have higher rates of BP than Africans in Africa. Further, race and ethnicity are independent predictors of HTN (Holmes et al, 2013).

Conclusion

Blacks and whites do differ in BP, and its aetiology is both complex and hard to untangle Genetic factors probably don’t account for a lot of this variance since Africans in Africa have low levels of BP compared to their black American cousins. Numerous lines of evidence shows that social and environmental factors are the cause, and so to change this, all people—especially blacks—should be educated on how to change these problems in our society. Whether discrimination is real or imagined, the effects of it lead to real physiological outcomes that then lead to increased health disparities between these populations.

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16 Comments

  1. ron burgundy says:

    stress has almost nothing to do with bp in the sense of “high bp”.

    hypertension is only diagnosed when it is NOT transient, but constant.

    though even in the worst cases, bp does fall enormously during sleep.

    Like

    • Phil78 says:

      Well he already shown otherwise.

      ” Psychosocial variables can also explain heightened BP (Marmot, 1985; Cuffee et al, 2014). Yan et al (2003) also note how “time urgency/impatience” and “hostility” “were associated with a dose-response increase in the long-term risk of hypertension.””

      “Kulkarni et al (1998) show that increased stress leads to subsequent BP elevations which, over time, will lead to HTN. In a 2009 meta-analysis, Gasparin et al show how “individuals who had stronger responses to stressor tasks were 21% more likely to develop blood pressure increase when compared to those with less strong responses.”

      He also posted study distinguishing acute versus chronic stress.

      https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/stress-and-high-blood-pressure/art-20044190

      “There’s no proof that stress by itself causes long-term high blood pressure. It may be that other behaviors linked to stress — such as overeating, drinking alcohol and poor sleeping habits — cause high blood pressure. However, short-term stress-related spikes in your blood pressure added up over time may put you at risk of developing long-term high blood pressure.”

      Like

    • ron burgundy says:

      i suggest you read your own quotes. they agree with me. and please stop confusing association with cause.

      hypertension is not “in your head”.

      in fact i’d bet if you took sendentary and out of shape men and subjected them to trench warfare say. when they got home their bp would be lower than it was before they left.

      i guarantee john mccain’s bp was lower after he was released from the pow camp.

      the idea that stress causes hypertension is an old wives’ tale.

      what is true is that out of shape people with poor diets are less able to deal with stress.

      calorie restriction reduces everyone’s bp to 100/60 irrespective of how much stress they may have. see luigi fontana’s data.

      hypertension is a “disease of civilization”.

      another old wives’ tale is that bp increases with age and this is just a normal result of aging. data from savages from the amazon to the trobriand islands show this is false. there are plenty of savages who do live to advanced ages. their bp is no higher than that of young savages. usually it’s lower.

      QED.

      Like

    • Phil78 says:

      “i suggest you read your own quotes. they agree with me. and please stop confusing association with cause.”

      Your comment had nothing to do with “cause”. You were talking about relation.

      -“stress has almost nothing to do with bp in the sense of “high bp”.”

      “hypertension is not “in your head”.”

      What a fitting simplification that someone of your mental capacity would put it.

      “in fact i’d bet if you took sendentary and out of shape men and subjected them to trench warfare say. when they got home their bp would be lower than it was before they left.”

      “You’d bet”, sure professor.

      “i guarantee john mccain’s bp was lower after he was released from the pow camp.

      the idea that stress causes hypertension is an old wives’ tale.”

      Yeah, and I’m sure you have plenty of evidence to refute RR’s own.

      “what is true is that out of shape people with poor diets are less able to deal with stress.

      calorie restriction reduces everyone’s bp to 100/60 irrespective of how much stress they may have. see luigi fontana’s data.”

      None of his studies mentioned psychological stress, unless you actually managed to confuse that with oxidative stress

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673798/

      https://www.sciencedirect.com/science/article/pii/S0092867415001865

      “hypertension is a “disease of civilization”.” RR agrees, that doesn;t mean there is only one cause or aggetator.

      “another old wives’ tale is that bp increases with age and this is just a normal result of aging. data from savages from the amazon to the trobriand islands show this is false. there are plenty of savages who do live to advanced ages. their bp is no higher than that of young savages. usually it’s lower.”

      Proof?

      This says otherwise.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392307/

      It’s lower than with other populations, but it does occur independent of modern influences.

      Like

    • ron burgundy says:

      that’s a review paper.

      it’s reviewing studies on genuine savages + semi-domesticated savages.

      if bp rises with age among savages it’s such a small rise it’s undetectable until maybe age > 70.

      why did you do that karen?

      Like

    • ron burgundy says:

      i assumed you had enough sense not to claim one study on one tribe was meaningful.

      i was wrong.

      and the study confirms what i said anyway.

      sad!

      Like

    • ron burgundy says:

      Yeah, and I’m sure you have plenty of evidence to refute RR’s own.

      he has NO evidence.

      just like he has NO evidence that blacks are better sprinters and jumpers because of their muscle fiber composition.

      and he has NO evidence because there is NO evidence.

      “stress” = “psychological stress” unless qualified.

      but it’s clear your native language is NOT english so it’s fine.

      why don’t you just comment as rr? or as peepee?

      Like

    • Phil78 says:

      “that’s a review paper.

      it’s reviewing studies on genuine savages + semi-domesticated savages.”

      It still discusses finding nonetheless.

      “if bp rises with age among savages it’s such a small rise it’s undetectable until maybe age > 70.

      why did you do that karen?

      i assumed you had enough sense not to claim one study on one tribe was meaningful.

      i was wrong.

      and the study confirms what i said anyway.

      sad!”

      Both of these quotes prove that you didn’t actually read the link, and to claiming that the study was meaningless is pretty hypocritical from someone who doesn’t even use evidence.

      Either step up, use research to support your claims, or quit whining.

      The study claimed that, while lower than many populations, increases with age were observed nonetheless. Whether you see them as meaningful or not is arbitrary.

      “Mixed-effects models reveal systolic, diastolic and pulse blood pressure increases of 2.86 (p < 0.001), 0.95 (p < 0.001) and 1.95 (p < 0.001) mm Hg per decade for women and 0.91 (p < 0.001), 0.93 (p < 0.001) and −0.02 (p = 0.93) for men, substantially lower than rates found elsewhere. Lifestyle factors, such as smoking and Spanish fluency have minimal effect on mean blood pressure and no effect on age-related increases in blood pressure. Rise in age-related blood pressure varies by distance to market and body mass index. Effects of modernization are therefore deemed minimal among Tsimane, in light of their lean physique, active lifestyle and protective diet.”

      “he has NO evidence.”

      Because saying something makes it true, and him allegedly not having evidence automatically means you don;t have too.

      Nice logic.

      “just like he has NO evidence that blacks are better sprinters and jumpers because of their muscle fiber composition.

      and he has NO evidence because there is NO evidence.”

      Except he has shown evidence in racial fiber difference, fiber differences contributing to different types of running, and even our discussions of Eurasian sprinter being more prominent at longer distance is consistent with long distance sprinting requiring more endurance.

      ““stress” = “psychological stress” unless qualified.

      but it’s clear your native language is NOT english so it’s fine.”

      You clearly don’t understand english here because I’ve shown that the type of “stress” Fontana discussed was completely different from the type of stress that RR is discussing.

      “Oxidative stress”=/= Stress that elevates bp in short spikes. Get that throw your head if that’s even feasible.

      “why don’t you just comment as rr? or as peepee?”

      Because your schizophrenia misguides you.

      “GOTT IM HIMMEL!

      this just proves what i said.

      and there will be variation from tribe to tribe.

      so after 50 years your systolic bp goes up by 5 points.”

      Your statement was that rises in BP weren’t a natural result of age, large difference in magnitude compared to other populations and variation between tribes doesn’t refute that.

      “it also used to be claimed that systolic bp less one hundred equals age in years on average and that this results from stiffening of the arteries which is itself
      a natural effect of aging.

      in reality it didn’t result from stiffening of the arteries and it wasn’t a natural effect of aging.”

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288978/

      This shows otherwise unless you have counter studies.

      “why don’t you look it up.”

      Because I’m not a lazy troll who talks shit about biology without the ability to at least recall studies.

      “i can’t find mccain’s records, but in general…

      no matter how bad the stress, prolonged calorie restriction results in lower bp.”

      And I’ve already told you that Fontana’s data does not deal with the type of “stress” we are talking about.

      “it’s hard to believe the level of trust americans have in their medical establishment. 99% of american MDs are more full of shit than you.

      stress is NOT an essential characteristic of the environment. it is a characteristic of the human mind and body.”

      It’s amazing how scientifically illiterate you are. Explain “Stress” aside, the fact that you resort to pre-science bullshit of seperating the mind and body in MEDICINE, and fail to understand how the mind and body are LINKED to responding to their environment, shows how idiotic you are.

      The fact that Stress indeed cause BP spike independently shows that the two are tied. That’s not contested, what is whether it causes hypertension.

      And, what is established, is that repeated episodes of stress related spike adds risk to long term spikes and that Chronic, rather than acute, would have higher chances to be linked to hypertension.

      “starvation is as stressful an experience as their is, yet it is one environmental intervention which reverses atherosclerosis and lowers bp to the 100/60 range.

      i’m in the bgi study and you’re a boring moron pill.”

      You’re an idiot who can’t identify a a non sequitor to save his life.

      “Starvation” is obviously NOT a situation that has stress working by itself, when regular consumption of nutrients is remove that automatically opens the door for other reactions to occur.

      Like

    • Phil78 says:

      BTW, the reason why BP decrease with starvation is due to hypotension due to factors like dehydration.

      https://en.wikipedia.org/wiki/Hypovolemia

      https://en.wikipedia.org/wiki/Hypotension

      Like

    • ron burgundy says:

      i HAVE given evidence.

      if you can read, go back and read it.

      5 points is 100% MEANINGLESS. bp varies by 5 points from minute to minute.

      are you retarded?

      and use ““…”” instead of quotes. quotes makes it obvious you’re rr.

      Like

    • ron burgundy says:

      BTW, the reason why BP decrease with starvation is due to hypotension due to factors like dehydration.

      btw, you have no clue.

      use italics or bold instead of quotes.

      Like

    • Phil78 says:

      “i HAVE given evidence.

      if you can read, go back and read it.”

      Let’s see, you referred to Fontana, I countered pointing out how his studies didn’t discuss Stress in the context as RR was speaking off.

      You referred to “savages”, I countered showing a lower rate of bp, but not none existant.

      https://www.vivehealth.com/blogs/resources/understanding-blood-pressure

      Here, roughly by decades, BP increases by 7 points decade points on average. Again, 5 points isn’t meaningless.

      “5 points is 100% MEANINGLESS. bp varies by 5 points from minute to minute.”

      Yeah, you are speaking of variation in a single individual at a certain age. That’s a different measurement than an average bp in a larger sample distinguished and compared by age.

      Small increases is different from insignificant. The study proves that other factors effect why Westerners experience more hypertension, but age being a factor isn’t ruled out especially on the environmental/population context.

      In other words, have this been demonstrated in actual western populations to find age as a non independent effect? Have age been consider to effect BP in combination with other factors as opposed to just being an associated metric?

      “are you retarded?”

      No, you can’t determine how to determine significant from insignificant figures.

      “and use ““…”” instead of quotes. quotes makes it obvious you’re rr.”

      Only in your persistantly rebellious mind.

      “btw, you have no clue.

      use italics or bold instead of quotes.”

      What difference does it matter to you? Until you actually cite sources to prove your point, you’re in no position to tell anyone to do anything.

      Like

    • ron burgundy says:

      you did NOT counter anything.

      you CONFIRMED what i said.

      you disagree with the mayo clinic.

      you can’t read.

      you don’t know what “non sequitur” means.

      you’re increasing my bp.

      come back to the argument after you score 30 points higher on an IQ test.

      THE cause of high bp in american negroes is:

      an anecdote: what could be more stressful than being president. yet obama had remarkably low bp, and he’s a negro. clinton had high bp.

      i win. you lose. sad!

      QED

      Like

    • Phil78 says:

      “you did NOT counter anything.”

      Yeah I did, your claims on Fontana and hunter-gatherers/

      “you CONFIRMED what i said.”

      No, I went into detail distinguishing small versus large increases in age. Reread my links.

      “you disagree with the mayo clinic.”

      didn’t you just criticize Americans for trusting medical establishments?

      “you can’t read.

      you don’t know what “non sequitur” means.”

      I do know what it means, and your example with starvation didn’t follow and even explained why hypotension occurs.

      “you’re increasing my bp.” I thought you said stress was of the mind and body?

      “come back to the argument after you score 30 points higher on an IQ test.”

      You comeback when you can actually fully articulate medical findings and not get frustrated like the ideologically driven hermit you are.

      “THE cause of high bp in american negroes is:

      an anecdote: what could be more stressful than being president. yet obama had remarkably low bp, and he’s a negro. clinton had high bp.

      i win. you lose. sad!”

      So you have racial samples, non random, of one person each and expect them to be representative without going into lifestyle?

      BTW, RR already included consequences pretaining to diet as one of the reasons BP is higher in African Americans.

      “Obesity also leads to hypertension (Re, 2009) while blacks are more likely to be obese than whites, however, black American men with more African ancestry are less likely to be obese (Klimentidis et al, 2016). This would imply that the greater amount of African ancestry in American blacks both protects against obesity and along with it HTN. Williams (1992) makes a convincing argument that environmental and social factors are the cause for the black-white BP gap. And while genetic factors are important, no doubt, environmental and social factors are arguably more important to this debate.”

      Also SES accounts for the lionshare of the gap.

      “Lastly, Langford (1981) shows that when SES is controlled for, the black-white BP disparity vanishes, implying that social and environmental—not genetic—factors are the cause for elevated HTN levels in black Americans.”

      If what you say is true, that would imply Blacks and whites of similar SES eat similar diets, but is that actually true as your suggestion would entail?

      Like

  2. ron burgundy says:

    Mixed-effects models reveal systolic, diastolic and pulse blood pressure increases of 2.86 (p < 0.001), 0.95 (p < 0.001) and 1.95 (p < 0.001) mm Hg per decade for women and 0.91 (p < 0.001), 0.93 (p < 0.001) and −0.02 (p = 0.93) for men…

    GOTT IM HIMMEL!

    this just proves what i said.

    and there will be variation from tribe to tribe.

    so after 50 years your systolic bp goes up by 5 points.

    it also used to be claimed that systolic bp less one hundred equals age in years on average and that this results from stiffening of the arteries which is itself
    a natural effect of aging.

    in reality it didn’t result from stiffening of the arteries and it wasn’t a natural effect of aging.

    Like

  3. ron burgundy says:

    why don’t you look it up.

    i can’t find mccain’s records, but in general…

    no matter how bad the stress, prolonged calorie restriction results in lower bp.

    it’s hard to believe the level of trust americans have in their medical establishment. 99% of american MDs are more full of shit than you.

    stress is NOT an essential characteristic of the environment. it is a characteristic of the human mind and body.

    starvation is as stressful an experience as their is, yet it is one environmental intervention which reverses atherosclerosis and lowers bp to the 100/60 range.

    i’m in the bgi study and you’re a boring moron pill.

    Like

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