Letter by Wexler and Feldman Regarding Article, “Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories: Results From a 15-Year Longitudinal Study in Youth and Adults”
To the Editor:
The research presented by Wang et al1 is an important contribution toward understanding and reducing disparities in health care in general and hypertension in particular. Although we agree with their conclusion that “further work will be needed to determine specific risk factors, both genetic and environmental,” we hope we will not forget that the explanation of a problem does not always equal a solution.
As pointed out in the editorial by Jones and Hall,2 “the challenges to understanding the science of racial differences and disparities in cardiovascular disease are substantial,” and the “study by Wang et al makes an important contribution to our understanding of racial differences in blood pressure.” Such information is vitally important, but it will provide very minimal benefit to African American patients unless we can address some of the cultural differences that also exist.
Many African Americans continue to be wary of the healthcare system, and with good reason. The research conducted at Tuskegee still resonates within the African American community. As such, any interventions developed on the basis of genetic or environmental risk must also address the cultural gap that exists in some African American communities between perceptions of hypertension and the healthcare system. This includes the beliefs that (1) foods such as pork cause hypertension,3 (2) pharmaceutical companies use patients to test medications,4 (3) physicians use authoritarian and ethnically inappropriate communication patterns,5 and (4) African Americans expect to be active participants in their care even though they may not be treated as such by physicians.6
Unless we work to overcome the cultural differences (both real and imagined) that also exist within health care, any treatment(s) for hypertension developed from a better understanding of genetic and environmental influences will not yield the hoped-for results.
Wang X, Poole JC, Treiber FA, Harshfield GA, Hanevold CD, Harold S. Ethnic and gender differences in ambulatory blood pressure trajectories: results from a 15-year longitudinal study in youth and adults. Circulation. 2006; 114: 2780–2787.
Jones DW, Hall JE. Racial and ethnic differences in blood pressure: biology and sociology. Circulation. 2006; 114: 2757–2759.
Merick PC. Rethinking the target corollary: the effects of social distance, perceived exposure, and perceived predispositions on first-person and third person perceptions. Communic Res. 2005; 32: 822–843.