African Americans and High Blood Pressure :

We examined the effect of stereotype threat on blood pressure reactivity. Compared with European Americans, and African Americans under little or no stereotype threat, African Americans under stereotype threat exhibited larger increases in mean arterial blood pressure during an academic test, and performed more poorly on difficult test items. We discuss the significance of these findings for understanding the incidence of hypertension among African Americans. Many studies have demonstrated that African Americans have a higher incidence of high blood pressure, or hypertension, than European Americans (for reviews, see Anderson, 1989; Folkow, 1982; Obrist, 1981). Some researchers have argued that genetic factors explain the higher incidence (Rotimi, Cooper, Cao, Sundarum, & McGee, 1994). Others have argued that social environmental factors explain the higher incidence; specifically, they have claimed that African Americans experience stressful episodes more chronically than European Americans, which leads in turn to the observed racial differences in hypertension (Anderson, McNeilly, & Myers, 1993; Clark, Anderson, Clark, & Williams, 1999). In the experiment we report here, we tested the latter notion by examining a specific type of stressor, stereotype threat, which may affect African Americans' hemodynamic reactivity. Steele and his colleagues (Aronson, Quinn, & Spencer, 1998; Spencer, Steele, & Quinn, 1999; Steele, 1997; Steele & Aronson, 1995; Steele, Spencer, & Aronson, in press) have presented a framework for understanding how stereotypes affect members of stereotyped groups. According to this framework, members of such groups experience stereotype threat when they are in situations in which other people may view them stereotypically in ways likely to increase performance pressures (i.e., stress). Research has shown that members of stereotyped groups (African Americans; Latinos; people of low socioeconomic status; women, in certain domains such as mathematics) perform more poorly on standardized tests, particularly on difficult items, than their nonstereotyped counterparts when stereotype threat is high. However, no such performance differences emerge when stereotype threat is low (Croizet & Claire, 1998; Spencer et al., 1999; Steele, 1997; Steele & Aronson, 1995). In the current experiment, we tested the hypothesis that increased blood pressure accompanies the stress or threat induced by stereotype threat among African Americans. Three lines of evidence converge to suggest that being subject to repeated episodes of stress may play an important role in the higher incidence of hypertension among African Americans. First, family history of hypertension does not appear to predict greater cardiovascular reactivity among African Americans, unlike European Americans (Anderson et al., 1986; Clark et al., 1999; Falkner, Kushner, Khalsa, Canessa, & Katz, 1986; Johnson, 1989; Morrell, Myers, Shapiro, Goldstein, & Armstrong, 1989). Second, repressing anger and angerprovoking manipulations, particularly ones in which racism provokes the anger, do produce greater cardiovascular reactivity among African Americans compared with European Americans (Armstead, Lawler, Gorden, Cross, & Gibbons, 1989; Harburg, Blakelock, & Roper, 1979; Johnson, 1989; Johnson, Schork, & Spielberger, 1987). Third, John Henryism, or the tendency to work extremely hard while not giving up on difficult and demanding tasks, has been strongly associated with hypertension in African Americans but not in European Americans (James, Hartnett, & Kalsbeek, 1983; James, LaCroix, Kleinbaum, & Strogatz, 1984; James, Strogatz, Wing, & Ramsey, 1987). Because African Americans face more situations in which they are stereotyped by others and consequently face a relatively high level of stereotype threat, a rare experience for European Americans, their comparatively high chronic blood pressure levels may stem, at least in part, from these multiple episodes of stereotype threat. Repeated episodes of acute blood pressure increases are thought to lead to chronically high blood pressure levels, or hypertension. Anderson et al. (1993) and Clark et al. (1999) have proposed mechanisms for this pathophysiological process. To test this reasoning more directly, we examined mean arterial blood pressure (MAP) responses of African and European Americans in situations in which the saliency of stereotype threat for African Americans was varied. We hypothesized an interaction between stereotype threat and race such that when stereotype threat was relatively high, African Americans would have higher blood pressure levels than European Americans, but when stereotype threat was low, no racial differences would occur.