Hypertension in the African American community: social, cultural, and psychological factors.

The potential influence of social and psychological factors on the risk of hypertension within the African American community must be examined in relation to cultural and historical influences on the community. Blood pressure elevation varies dramatically between and within black populations, with socioeconomically disadvantaged communities in North America showing the highest levels. It is this historical and continuing pattern of socioeconomic disadvantage that forms the context in which social and psychological factors must be examined. The research that is reviewed in this article explicitly takes into account such factors. It is consistent with a model in which African Americans are engaged in a chronic struggle to achieve and maintain valued social and personal goals in the context of few socioeconomic resources. This long struggle is itself associated with higher blood pressure, and may also lead to the greater experience of frustration and anger that compounds blood pressure elevation. Conversely, there are also supportive social institutions in the black community, including the church and the extended family, that appear to provide a protective effect with respect to problematic circumstances and lower the risk of hypertension. The twin goals of lowering blood pressure therapeutically and preventing the onset of hypertension must include the social and cultural context of African American patients, and the social and psychological processes associated with hypertension.