The association between racial identity and hypertension in African-American adults: Elevated resting and ambulatory blood pressure as outcomes

Objectives: This study investigated the association between Black racial identity attitudes and hypertension. It was hypothesized that racial identity attitudes characterized, in part, by an intense focus on African Americans as a group and a general rejection of White individuals and culture (termed transitional identity), would be associated with elevated blood pressure. It was also hypothesized that the experience of stress and hostility or cynical mistrust associated with transitional identity would account for this association. Methods: Participants were 126 non-obese African-American men and women (mean age 53.8 years) with normal blood pressure or minimally treated hypertension, recruited from among individuals enrolled in a study of risk factors for atherosclerosis in south-western Pennsylvania. Participants completed assessments of racial identity, hostility, perceived stress, and race-focused situational appraisal. Physiological measures included resting and daytime ambulatory systolic blood pressures (SBP) and diastolic blood pressures (DBP), as well as nocturnal declines in blood pressure. Results: Transitional racial identity attitudes significantly predicted resting SBP (P<.03) and DBP (P<.002), as well as ambulatory SBP (P<.001) and DBP (P<.0004), when adjusting for demographic variables. Transitional identity remained a significant predictor of resting DBP (P<.01) and ambulatory SBP (P<.02) and DBP (P<.006), when hostility and perceived stress were also controlled. Conclusions: Results suggest that transitional racial identity may be an important correlate of elevated blood pressure in African Americans and that this association cannot be fully accounted for by measures of perceived stress or hostility.