title: Exploring the association between reported discrimination and hypertension among African Americans: a systematic review.
abstract: BACKGROUND
  The experience of racial discrimination among African Americans may contribute to an increased risk of developing hypertension and having poor hypertension control once diagnosed. Although it is a commonly held belief that experiences of discrimination may exert lasting effects on health behavior and physiology, the existing evidence is mixed.
  
  
  OBJECTIVE
  The objective of this review was to identify evidence linking the experience of discrimination with hypertension among African Americans and to provide an updated synthesis of the literature.
  
  
  METHODS
  Articles for the review were identified through an electronic search of PubMed, OVID, and other pertinent journals. The review was augmented with a manual search of references. We assessed the quality of included articles using modified Downs and Black criteria.
  
  
  RESULTS
  In total, 15 articles were selected for the review, 12 cross-sectional studies and 3 cohort studies. The preponderance of evidence (9 of 15 articles) indicated that discrimination was associated with an increased risk of developing hypertension, difficulty obtaining control of existing hypertension, and/or elevated blood pressure among those without a diagnosis of hypertension.
  
  
  CONCLUSIONS
  This systematic review supports the association of racial discrimination with an increased risk of developing hypertension; however, the picture is not uniform. Methodological challenges, such as floor or ceiling effects of reported discrimination and low sample size, may have prevented researchers from detecting important associations. A better understanding of the emerging but complex relationship between discrimination and hypertension among African Americans is needed, as we seek to resolve existing cardiovascular health disparities.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA. yendelela.cuffee@umassmed.edu
authors.forename: Yendelela L
authors.initials: YL
authors.lastname: Cuffee
authors.forename: J Lee
authors.initials: JL
authors.lastname: Hargraves
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000208:ethnology*; D063505:Racism / Q000208:ethnology / Q000706:statistics & numerical data*; D012307:Risk Factors