The effect of an individual’s race on their hypertension status: an analysis rooted in nativity and discrimination

OBJECTIVES: Hypertension, or high blood pressure, is an undeniable public health crisis, affecting an estimated 1.28 billion adults globally, acting as a primary risk factor for chronic diseases, and largely contributing to premature death. Prior research suggests that minority individuals are at a heightened risk for both discriminatory experiences and hypertension. Simultaneously, some studies have identified a protective effect among foreign-born minorities - referred to as the epidemiological paradox. Few studies have assessed the intersecting effects of race, nativity, and discrimination on hypertensive risk and prevalence. METHODS: Using data from the 2023 National Health Interview Survey (n = 29,522), a series of progressively adjusted logistic regression models were utilized to determine the odds ratios for hypertension by race, accounting for relevant demographic and socioeconomic covariates and self-reported nativity and experiences with discrimination. RESULTS: Black individuals had higher odds of hypertension across all models as compared to White individuals, while Hispanic individuals had statistically significant lower odds of hypertension. Foreign-born nativity status emerged as a modest protective factor. Sex, age, and general health status were the strongest predictors of hypertension, while discrimination was not statistically significant in the fully adjusted model, potentially due to measurement limitations. CONCLUSION: Public health initiatives should prioritize age- and sex-specific, racially informed strategies to reduce hypertensive risk and improve treatment outcomes. Findings challenge anti-immigrant narratives by suggesting that an individual's nativity status may have protective effects against chronic health conditions.