The unidentified cause of one man’s hypertension: Racism

The unidentified cause of one mans hypertension: Racism

Meet Damien, my Facebook friend, photographer, and IT guy.

This morning, he messages me: “I would like to make an appointment.”

I reply: “For?”

“High blood pressure.”

I offer to see him, but he never comes in. Weeks later, he writes, “I got busy Pam. How are you? High blood pressure pills keep making me sick. I am doing the best I can. On bad days it is like 208/118.”

Friends don’t let Facebook friends die. And 208/118 is incompatible with life. I’m a family doc–a-sleuth. It’s my job to spy on people. On Damien’s page, I find a dozen photos of lynchings — his reaction to today’s Trayvon Martin verdict. A black boy murdered in a land where killers roam free. Trayvon died a senseless death, but Damien shouldn’t have to. I suspect today is a bad day for Damien’s arteries. So I call him up. “I’m worried about you, man. I’m coming over to check on you tonight.” An hour later, I’m in his living room.

The unidentified cause of one mans hypertension: Racism

Damien didn’t always have hypertension. As a child, he loved music, dancing, and cruising around the neighborhood on his red tricycle. He was peaceful, happy–until the day he saw two dark men on the hood of a police car. “The police were beating the crap out of them. I asked my dad why. He said, ‘Son, this is the way things are. You’re gonna have to get used to it.’”

I ask Damien about his family.

“There’s high blood pressure on both sides of my family. Mom was diagnosed at 13. I’m of Jamaican, African, and Native American descent. I didn’t know much about my ancestors until recently,” he explains.

The unidentified cause of one mans hypertension: Racism

“In junior high, I was taught my people were slaves. After class, I asked my history teacher if Native Americans and Africans were anything more than just slaves. Did they do anything great? It was an innocent question. I was curious. Genuinely concerned, my teacher put his hand on my shoulder and said, ‘Damien, it’s unfortunate, but it’s true that white people are superior to black people and Indians. The only hope for your people to get out of the situation they are in is to get an education and buy property.’” Damien was shocked. He explains, “We are taught that we’re a slave race. It’s a psychological weapon. No doubt about it. The message I received in school: You guys are slaves. We kicked your ass. And here’s all the great things we’ve accomplished as a result. That’s American history.”

“So how did you end up in Oregon?”

“Los Angeles is a dangerous place to be black. I’ve lost a lot of friends to violence. I’ve seen people get shot. I’ve watched them die. Back home, when a black man calls for help, police show up to harass him. I’ve been denied jobs, even hotel rooms, because I am black. Back home, I always dress nice. Yet a white woman will look at me with a frightened expression, grab her purse, and move away from me like I’m going to mug her. I am a friendly guy. I’m here because I got sick of being shut down.”

“Mind if I check your blood pressure?” Damien sits on the sofa, takes a deep breath, and offers me his right arm. “Wow. It’s 150/89–better than I thought. Let’s check the other side”

Suddenly, there’s a knock on the window. A flashlight shines into his living room. Before I understand what’s happening, Damien’s hands are up in the air. A police officer tells him to come outside. We learn that the cop is searching for a lady who’s driving recklessly through the neighborhood.

I’m relieved that nobody is hurt, but Damien is agitated. He’s pacing. His post-police blood pressure: 205/109.

He sits down. He stands up. He sits down. I check him again: 189/105.

He stands up. He calls his daughter. “Hey sweetie, I need you to get down if you hear anything. I love you.” She’s visiting his mom in L.A., where drive-by shootings are the norm. “My mom jumps in the bathtub when she hears gunshots,” he tells me.

I recheck his blood pressure: 167/98.

“Hey Damien, can you tell me what medicine your doctor has you on?”

“I’ve been on so many pills. Most recently lisinopril. But my pressure went up. My heart was racing. I got anxiety. Doctors have been giving me experimental drugs for years. White men’s medicine doesn’t work for me.”

Maybe taking white men’s medicine – drugs developed by one’s oppressors — raises blood pressure. I never thought about that before, but it makes sense now. Could be the anti-placebo effect.

“Why don’t you lie down, relax? I’ll make you some tea.”

In Damien’s cupboard, I find hibiscus. “Hey, do you know hibiscus is native to Jamaica? It even has blood pressure lowering effects.”

As he sips his tea, I help Damien understand what’s going on. “Emotional distress clamps down your arteries and causes you to retain sodium. When you raise your blood pressure, you are beating yourself up inside–punching your heart, brain, kidneys with each heartbeat. Try to let go of your fear and anger, Damien. Don’t internalize the racial oppression, man. Please …” I lead him through a meditation to release his inner torment. Thirty minutes later, my friend’s blood pressure is 136/72.

People with hypertension die prematurely of heart disease, stroke, kidney failure. I think I know why Damien developed such high blood pressure. I consult Harrison’s Textbook of Internal Medicine and confirm the sad statistics: urban blacks have twice the prevalence of hypertension as whites and more than four times the hypertension-induced illnesses. A chart lists risk factors for bad outcomes in hypertensives. The top three: black race, youth, male sex.

Maybe Damien is carrying the pain of his ancestors who were kidnapped, shackled, brought here against their will. Maybe his arteries clamp down when he sees cops because so many of his friends were harassed, rather than protected, by them. Maybe his body is responding normally to the daily stress of being a black man in America.

Damien’s is 45. Since his early 30s, doctors have diagnosed him with essential hypertension, a form of high blood pressure for which no cause can be identified. Essential hypertension is a cop-out, a trashcan diagnosis. Why? The majority (95%) of hypertensives are dumped into this category. We tell them to lose weight, stop smoking, avoid salt. But Damien isn’t obese. He doesn’t smoke cigarettes. He rarely drinks alcohol. He eats mostly lentils and rice. The guy drinks lemon water.

“Essential” means absolutely necessary, vitally important. To treat essential hypertension, it’s absolutely necessary and vitally important to understand why a human being would develop blood pressure incompatible with human life. For Damien, the “unidentified” cause is racism.

“Unimportant” is the opposite of “essential.” To be satisfied with the diagnosis of essential hypertension is to declare the real cause unimportant — and that’s exactly how racism makes people feel.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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  • Sheila Swan Lafuer

    This is an example of a REALLY good doctor!

    • John C. Key MD

      Yes, she even carries her own cheerleading team.

      • PamelaWibleMD

        They are stalking me.

  • NormRx

    Cardizem works great in blacks for lowering BP. Also Damien will not have to worry about it being developed by the white man since it was developed in Japan

    • PamelaWibleMD

      Good to know. I do think there is an anti-placebo effect for patients who feel they are being victimized by western medicine-thought-patriarchy. I see this all the time. How we treat patients when we are prescribing a medicine (and how well we care to understand what is causing their problem in the first place) really impacts the ultimate success or failure of a medication regimen.

  • John C. Key MD

    The stress of racism can indeed by a factor in hypertension but it is really counterintuitive to suggest that it is THE cause or even a major cause of hypertension. And, of course, for the last decade or two we have been told that it is racist to consider racial differences in hypertension treatment. Scholarly, sensible articles on treatment of hypertension in blacks are condemned, we are told, as racist nonsense.

    Is your account given here a true clinical history, or merely a composite story for illustrative purposes? Having been raised in an extremey racist part of the country the account of the middle school teacher telling a middle school student 30 or 35 years ago that blacks were hopelessly inferior–it strains credulity. Likewise the police raid during a medical house call.

    My practice is in a primarily black population with age range of 18-75. Many have hypertension. Perhaps 5% are difficult to control. Helpful clinical information is desired; unnecessarily promotion of racist victimhood is not. I apologize for speaking frankly but I do not see how articles such as this one are at all helpful.

    • PamelaWibleMD

      100% factual. Police knocked on the window during a baseline blood pressure measurement. I had just taken it on the right arm and was moving to the left when the police came. I felt like I was in a movie scene.

      The middle school teacher said this verbatim about 30 years ago. Why else would a child remember this much detail from three decades ago if it were not so traumatic?

      Chronic stress from discrimination causes elevation in blood pressure. How would you explain the sad statistics I found in Harrison’s Textbook of Internal Medicine?

      • John C. Key MD

        As I said, I agree it is a factor I just don’t see that it is a major factor. I also wonder why no one recommends treating it with anxiolytics and SSRIs–I’ve never seen that recommendation.

        • PamelaWibleMD

          He was given these treatments (Zoloft is one I recall at the moment) and they failed to help him. Eradicating violence, income disparity, job, housing discrimination, the way we look at each other fearfully on the street, and police brutality is the ultimate solution.

          But first we need to claim these as actual medical (not just social) problems. Some people do not even believe racism still exists.

          How does a non-specific diagnosis of essential hypertension help us?

          • ninguem

            Hold on, I’m getting that down…..

            eradicate violence,
            eliminate income disparity
            eliminate job discrimination
            eliminate housing discrimination
            make people look nice to each other on the street
            and eliminate police brutality

            That’s going to need a big prescription pad.

            Look nice to each other on the street I think is OTC, but is eliminate police brutality scheduled?

            I don’t think I can phone in the police brutality prescription, the desk sergeant told me what to do with my prescription but I don’t think it’s anatomically possible.

          • PamelaWibleMD

            “People say I’m a dreamer, but I’m not the only one.” Ok. So I am a perpetual optimist. I believe people are basically good. And those who appear not to be are afraid of something. Maybe themselves.

  • PamelaWibleMD

    Aw . . . thanks Benton! Love the “call to compassion” on MLK Day.

  • PamelaWibleMD

    Thanks for sharing your fears and your compassion. This is how healing begins.

  • PamelaWibleMD

    We all have our ancestor’s traumas lurking somewhere . . .

    • Kerry

      It would be interesting to know which side of the ancestory equity line ninguem and John C Keys fall into.

      • PamelaWibleMD

        Let’s ask them . . . guys?

        • ninguem

          Hispanic. Mrs Ninguem is black.

          Unlike the President, I really do have a son who looks like Trayvon.

          • querywoman

            NInguem, would you let him go out alone at night with a hoodie?

        • John C. Key MD

          White, Raised on a small farm in rural Texas. Worked my way thru college and med school. Operate a free recovery home from persons exiting rehab and jail. None of which has anything at all to do with treating hypertension and addressing the needs of hurting people. I work with the poor by choice in order to help them improve their lives. Magnifying victimhood and making oneself feel better through pop psychobabble does nothing for the disadvantaged. Running on and on about white privilege and ancestral slavedholder demons isn’t going to get the BP down and prevent a stroke nor get them a job or a leg up in life. Welcome to reality.

          • Kerry

            Just a couple of words that jumped out at me, “Operate”, “Choice”, “White”. None of this sounds like it would be similar to Damian’s ansestory. Your work I’m sure is admirable, but I’d be careful with the tone you set, It’s likely to raise hypertension in some.

          • PamelaWibleMD

            Just discussing racism is likely a blood-pressure raising event.

            Polarization is not helpful. So my attempt here is to bridge the divide by presenting racism in the context of its impact on one man’s arteries.

            I don’t expect everyone to agree with the piece, but I do hope that we can have compassion for the very real suffering (BP > 200/100) of one man who has certainly been negatively impacted by racism.

            By the way, this is a toned-down version of actual events in his life. I did not want to overwhelm and lose the reader with the actual details of what this man has survived.

          • Kerry

            I apologize for my snarkiness, but it has been my experience that the educated ones often have more privilege in getting themselves to be just that, and the prevailing assumption that goes along with their privledge is that they are superior, which in turn gets translated on a daily basis in every walk of life.

          • ninguem

            So what great insight did you get, knowing our ethnic backgrounds?

            I’m the first college-educated in my family, ever. I grew up bilingual in a blue-collar ethnic barrio.

            Mrs Ninguem’s father has a bunch of “first black” stories in his long career as a surgeon.

            When I saw her father’s old homestead in the South (since demolished), I took a picture of him and his family, with my wife and son, in front of the house, holding the hand plow their father used to scour out a small hardscrabble landholding to plant food for his family and to sell.

            What I found of interest, was my grandfather had the same hand plow on his hardscrabble landholding to scrape out a living for his family.

            My mother has kept it over the years.

            The teacher’s first bit of advice, about whites being superior to others, is…….unfortunate……to put it mildly.

            The second bit, about getting an education and owning property, on the other hand, is quite right.

          • Kerry

            Sounds like very interesting backgrounds with lots of success to follow. I suppose there could be other factors that could explain this further, but it seems like a lot of odds have been surpassed. Many others follow in the same success against great odds, but I can’t say that those living in inner city dwellings have been able to accomplish this as a whole. “Just pull yourselves up by the bootstrap” is a hard message to have to take in today’s society. Perhaps from your perspective it always has been.

          • PamelaWibleMD

            Why is it that underprivileged can be found in the dictionary, but overprivileged is not in common use?

          • Kerry

            Because the underprivledged aren’t involved in assigning words or their definitions in the dictionary? And I think there’s a lot that is invisabie when it comes to privilege and discrimation.

          • PamelaWibleMD

            Dictionaries are written by the overprivileged who do not care to assign a definition to the word. Is that what you are suggesting, Kerry?

          • Kerry

            Yes, that’s what I’m saying, but I’m not certain they are aware of it. When I was out in the world i saw two main behaivor’s, superiority and inferiority. To a large extent I believe the superior’s really believe that they are “Superior”. They do not see themselves as privileged, but on the other hand the majority who are following are mimicking this behavior in order to follow in the “Superiors” footsteps. If there could be a shift in the way that privledge get’s transferred down, and a realization that privledge is often just that and not superiority, I think we could have a better impact on discrimination. Many of the descriminated are forced to adopt descrimnating behaivor’s and they will in order to succeed. You asked, LOL

          • PamelaWibleMD

            Thanks Kerry. Your opinions much appreciated.

          • DoubtfulGuest

            Dr. Key, I’m not a fan of pop psychobabble, either, but I was sort of wondering how long this post would stay up before someone invoked “victimhood” as a counter-argument. Since I saw Dr. Wible’s article right away, I actually considered timing it, but then I remembered I had work to do. I’m no expert on racial discrimination, but I wonder, what would be acceptable parameters for a discussion on this topic that would not incite people here to respond with the ‘v’ word? I’m asking you, but others here might give some insight as well. I also don’t know what to think about the middle school teacher’s story straining credibility. I tend to believe what people tell me about themselves, until I have a concrete reason to question it. That would include any experience that you shared here. Stepping back from your own experience with racial issues, come on, most of us here probably had at least one teacher who said stuff that was way out of line? From a medical perspective, I do have concerns about assigning cause and effect. I imagine that in other circumstances (a doctor who can’t make house calls, a less common condition than hypertension) that a serious diagnosis could be missed if ANY of a patient’s socioeconomic problems or traumatic experiences are over interpreted in a medical context.

          • PamelaWibleMD

            Yes. Curious how we go about discussing polarizing topics without polarizing. I thought a journey through one man’s arteries would allow for non-reactionary discourse.

          • querywoman

            Poor-looking white people with bad teeth get marginalized too.

  • PamelaWibleMD

    Hahaha!!!

    • ninguem

      And I gave them the picture right off the back of the book. I was real careful this time, ’cause last week they arrested a goat, it was very embarrassing.

      I guess that $100 bribe doesn’t go as far as it used to.

      • PamelaWibleMD

        I’m lost now.

        • ninguem

          Honest I really didn’t call the police on you.

          I wouldn’t do a thing like that.

        • querywoman

          Hee! Hee! I figured it out. He gave the cops pix of you and the goat. They thought the goat was Pamela Wible.

  • Chiked

    It is easy to blame racism but the modern lifestyle today is stressful and in the case of black americans, is far removed from what their ancestors ever faced. My buddy, a 44 year AA male is a single father with three young kids. I cannot remember the last time he had over 5 hours of uninterrupted sleep. That alone will raise your blood pressure.

    • PamelaWibleMD

      Yep. You never know what stressors people are truly living with unless you follow them around for a day.

  • PamelaWibleMD

    I see a connection . . . some of these folks seem like my patients

  • http://www.ValenciaRay.com/ Valencia Ray M.D.

    Absolutely. The most effective way to transformation that lasts and works for the good of all of course is by changing consciousness…police included.

    • PamelaWibleMD

      How do you suggest we do this? Is there a fast-track method?

      • http://www.ValenciaRay.com/ Valencia Ray M.D.

        Yes, I think so, it fast tracked mine and I’ve been surprised as what I’ve seen so far. It’s not just meditation though, it also a concept of understanding how to, “optimally operate” your brain. It’s become aware of the basic “operating system” of our brain. That’s what The Art and Science of NeuroReInvention is about. It’s my work in evolution. It can’t be done in an academic theoretical way though, that will put a lot of people to sleep.

  • PamelaWibleMD

    Well, my nephew calls me “Ms. Magoo.” Remember the cartoon Mr. Magoo?

    http://www.youtube.com/watch?v=t8GTHXTEvIc

    • PamelaWibleMD

      I kind of drive like this so it is plausible that the cops were looking for me. I don’t drink alcohol or any drugs though. Good thing.

      • Home Office Mommy

        Watching that clip after reading this potent piece just lowered my blood pressure and I don’t even live in the U.S.! That’s powerful healthcare Dr.! Check out this interview and see how our brain was created to strengthen everything including our heart. http://www.youtube.com/watch?v=aGg-9xFDs6U

        P.S. Mr. Magoo was the theme for my husband’s 50th birthday. Awesome!!!

  • querywoman

    A specifically helpful diagnostic incident!
    I’ll put more on this later, Pamela, but now I’m recovering from something flulike.
    The many years I worked in public welfare taught me that most lower income have homes, running water, toilets, air, and heat, but they are more vulnerable to crime. You know that this means lower income people of any color, race, or religion. The rich with all their luxuries are less vulnerable to crime. They can afford protection.

    My welfare women were always getting their purses stolen while waiting for the bus, etc. I grew up a a world that doesn’t exist anymore: white with some Hispanic blue collar neighborhoods. Not glamorous, but very safe. My family moved to suburb when I was 17 with dilapidated 3 bedroom homes because the area is built on a river bed and the foundations were shot. I hated that street and that house. But, the neighborhood was so eerily quiet in the daytime a major break-in might not have been noticed.
    Then I worked in public welfare in the big city, not so far away! Wow!
    After that, I briefly worked for the IRS in a downtown city. I said something about the homeless stealing from each other. One of my new coworkers said, “But they don’t have anything.” The IRS security told her, “They’ll steal shoes from each other.”
    No people is necessarily better or worse than another. Mexican prisons allow conjugal visits, and they don’t have a rape problem as in the US prisons. They also let a woman keep her child with her up to age 5.
    When Iran locked up 3 American hikers in Evin prison, they eventually let the two men take walks with the woman. American prisons won’t let the men and women mingle.

    • PamelaWibleMD

      Fascinating. Conjugal visits in prisons. Now there’s a topic I have never thought about . . .

      • querywoman

        If you have time, research conjugal visits in prison. I’ve researched you before. Didn’t you and/or your parents train in Galveston? You might have heard some of the same stuff I’ve heard about Texas prisons.
        In Texas, we always hear how horrible the Mexican prisons are. It’s subjective. I don’t think Mexican prisons require that a prisoner be married to have a conjugal visit either. I also think they allow a whole family in to visits a prisoner for a weekend or so. I really don’t think American prisons should take newborns from their moms. Some American prisons are letting them keep their babies a while.

        I barely knew about Evin Prison in Iran till a few years ago. Well, the Evin Prison clearly allowed the American male and female hikers to mingle in the yard because they thought it was good for them. They had ring a bell and go to the bathroom blinded, though. I’m glad we don’t blindfold our prisoners.
        My father was from another southern state. I was researching Evin Prison shortly before he died. I told him about Evin Prison before he died and that I really didn’t think it much worse than Huntsville, other than that inmates can be executed unexpectedly.
        Inmates get whipped in Texas prisons too!
        I’ve heard awful stuff about Huntsville all my life, like about a paraplegic being denied his wheelchair and having to crawl across the yard.

        • PamelaWibleMD

          Yes, I traine din Galveston and worked with death-row prisoners during medical school. No conjugal visits offered.

          • querywoman

            Pamela, I just did a 2 day stay in the medical lockup for pneumonia. Got out a few hours ago.
            I don’t know if death row inmates ever get conjugal visits anywhere.
            I assumed you know plenty about the hellish Texas prisons but they’re probably pretty hellish where you live.
            Before I went to hospital, I was researching medical care in Texas prisons. And that’s enough to make me sick in a way you doctors cannot help.
            Yuck! Getting back to normal, typing and popping off.
            Once years ago I researched crimes that put people on Texas Death Row. And that really made me sick! Florida and Texas have some really depraved criminals.

          • PamelaWibleMD

            I used to work on death row in Texas.

          • querywoman

            Ugh! The actual death row in Huntsville?
            I had a socially responsible internist once who volunteered at a county hospital. She said they stuck her in the jail, and she hated it. It was something about the men and the women standing in lines and seeing too much of each other’s bodies.

  • querywoman

    Now I feel like popping off more. I have been afraid of dogs all my life. No one knew why. I’d run home from school with a big dog at my side and my heart pounding.
    In my 40s, I got dx’d with Asperger’s Syndrome, and then I understand. The sudden rush of the dogs running up and me and barking overstimulated me.
    I have an exaggerated fear and flight syndrome.
    I mentioned my Asperger’s to a very good family doctor once. He told me Catapres was very useful for Aspies. He wrote me up generic clonidine 2x daily and told me to check my BP. We added a 3rd dose due to rebound.
    The clonidine does not make non-austistic, but it has increased my ability to cope.
    Your patient has stress reactions. Have you tried clonidine?

    • PamelaWibleMD

      Nope. He is not a patient. He is a friend.

      • querywoman

        Sounds like he became your patient at least for an hour or so.

  • Suzi Q 38

    Interesting story.
    I am just not sure what is the point, and I am a “fan” of Dr. Wimble’s.

    Being a person of “color” does not automatically mean that you will be hypertensive. Should the Hispanics, Asians, American Indians, Indians, and other minorities fear, distrust, and resent whites? Should they resign themselves to a life of elevated or extremely high blood pressure?

    How about those of us that are in the middle….half whites….or half minorities….aren’t these people treated poorly by both races and therefore more susceptible to stress and racism on both sides?

    How about being of mixed race (part white) and living in a black community? I experienced this first hand as a child, and it was’t easy. Although I am not being politically correct, can I blame my hypertension on the beatings I experienced as a child in my majority African American neighborhood streets?

    Hardly.

    I acknowledge racism exists on many fronts, but I am not sure that we can assign it as the root cause of hypertension. I will concede that it could be one of many reasons…family history, diet, exercise and weight are primary.

    • querywoman

      I threw in my opinion that the poor are more at risk of crime partially to show that any disadvantage group is vulnerable to stress.

      Pamela wrote about it as being his reaction to stress. As luck would have it, she saw him react to a major stressor. Then, she was able to help him bring it down through meditation.
      She saw a blood pressure rise in this person as stress-related. That may not be the case for all types of hypertension.
      Noise and other stimuli are stressors for my high functioning autism, and clonidine helps lessen the response. Clonidine helps block adrenaline. We have no idea how many other fear and flight hormones there are.
      My own pulse has been stressed the past few days due to deyhyrdation and flulike symptoms.

      • PamelaWibleMD

        Racism is one cause for hypertension in one individual. I am not suggesting this is the major cause for others. I treat every person as an individual. We can learn so much more in a housecall than in a 10-minute visit.

        It’s so important to stop categorizing people with non-specific diagnoses and take a real interest in what is causing their ailments.

        • Doug

          I think what some of the folks reading this are perturbed by is the somewhat cavalier usage of “racism.” Stress caused this man’s hypertension. In this case – yes I understand it’s the use of one man’s story to create greater awareness that racism can lead to medical stress – the stress was caused by his conditioned response to racism. But to say “racism causes [insert health event]” is a bit too journalistic. I’d like to think in healthcare we should be above fishing for controversial headlines.

          • PamelaWibleMD

            Stress induced by racism does not seem controversial. It exists.

            Racism is not often appreciated by those who do not experience it and creates daily stress for those who do.

            http://www.youtube.com/watch?v=8SIINVfqnxw

          • Doug

            I was unclear, I apologize. The controversy I speak of isn’t that racism can cause stress. That is quite evident. The controversy I note is in titling the article the way it is, which seems to be a baiting headline, rather than saying “Racism-Induced Stress.”

          • PamelaWibleMD

            My original article was titled Racism-Induced Hypertension here:

            http://blog.oregonlive.com/health-care/2014/01/a_case_of_racism-induced_hyper.html

            Kevin Pho changes titles when he posts on his site. I have no control of that.

            I do think that inserting stress between racism and hypertension kind of waters down the meaning. I would guess that a few individuals (such as Damien’s very mellow dad) could go through life experiencing racism and not have a cardiovascular hyperreactive response. But I suspect most people who experience the degree of racism that Damien has (I included just a few mild examples in the essay) would proceed straight from racist attacks to hypertensive episode.

            Racism-Induced Stress is not as specific as what I witnessed–a BP of >200/100. Essential hypertension is also non-specific. He has documented Racism-Induced Hypertension.

            Why is it so hard to accept this diagnosis?

          • Doug

            This is a straw man argument.

            I do not disagree that this man’s acute hypertensive episodes are caused by his perception of racism, and the habitual racism present in his life. But we live and work in Medicine. Capital M. Nomenclature is important. And to call it “Racism-Induced Hypertension” even, as your original article does, is baiting. It’s being provocative for something non-provocative. It’s baiting people to say “Hey, racism is causing hypertension. Not stress.” When in actuality it’s still stress, which we know and accept as a cause of hypertension. And we know and accept that racism causes stress. We don’t accept racism – and as a society we continue to fight against it – but the nomenclature stands. So why can’t we just call it stress-induced hypertension owed in this patient to racism? In another patient it could be owed to working at Walmart. Should we call that Walmart-Stress? And so rather than telling the world that EVERYTHING causes hypertension, because different things are stressors for different people, we just call it stress-induced hypertension.

          • PamelaWibleMD

            I favor the more specific term myself, but I your stress-induced hypertension is far better than essential hypertension.

          • Suzi Q 38

            Don’t forget the stress-induced hypertension when the doctor comes in your room with h/her white coat and takes your BP.

          • PamelaWibleMD

            How can we forget that? Even happens without the white coat. . . .

          • PamelaWibleMD

            Doug, what do you think caused his stress-related hypertension?

          • PamelaWibleMD

            Would hypertension secondary to stress secondary to racism be more palatable?

    • PamelaWibleMD

      The point of the story: To understand the impact of racism on one man’s arteries. This is not so much an intellectual exercise, but a call to compassion for the documented suffering in another human being.

      • Suzi Q 38

        Thank you!

  • PamelaWibleMD

    Most certainly true.

  • Freddie Thiemer

    The Buddha said that with our minds we create the world. And yes of course we are all responsible for our own thoughts. But let’s be honest it’s hard to have good thoughts when there is still so much hatred bigotry and dishonesty in our culture. If we could just all love one another. We are all one. Some of us just take too long to figure it out.
    Love is all we need.

    • PamelaWibleMD

      Exactly. The answer is so simple.

  • ninguem

    “Los Angeles is a dangerous place to be black”.

    Not too long ago, Oregon wasn’t much better.

    Oregon Constitution of 1859 had a Negro Exclusion Law (Article 1, Section 35). Repealed in 1926

    Article 2, Section 6 prohibited right of suffrage to any “Negro,
    Chinaman, or Mulatto”. Repealed in 1927.

    In Waldport, Oregon, driving the Alsea River Road one time, I saw a street sign for “Darky Creek Road”.

    Sure enough, the old street name meant exactly that.

    http://www.oregonencyclopedia.org/entry/view/southworth_louis_1829_1917_/

    Sometime after the ex-slave bought his freedom, he settled on the land. He died in 1917. Locals kept the name. There was a fight in the late 1990’s, ‘cause the State wanted to change the name to Southworth Road. Locals wouldn’t hear of it.

    • PamelaWibleMD

      Familiar with the Eugene sundown laws?

    • querywoman

      Could institutionalized racism return swiftly in the US?

      • ninguem

        There’s an old saying,

        “The dark cloud of fascism looms across America, but always lands in Europe.”

      • PamelaWibleMD

        It’s still here. When did it end.

        • querywoman

          “Institutionalized” racism means sanctioned by law.

          Historically, disabled people have had no rights. They have sued the American government and got protections that are not available to them in many other countries.

  • PamelaWibleMD

    Good points.

    I am his friend, not his doctor, so all I didi was check his BP and it was the same basically sitting and standing. This sit-to-stand-to-sit thing was a sign of his agitation. He thought the cop was gonna shoot him. Cops hand was on his gun. Other one had the flashlight.

    Since I ave never had a bad experience with the police, I just don’t have theses very real fears.

    Since my friend has no insurance, he has not been able to get a full cardiovasciar workup. I’ve suggested tests though.

    • querywoman

      I assume that your friend is an educated, culture black man. I also consider his reaction to the cop as normal for a black man.
      I also firmly believe that women of color are more vulnerable to street violence than white woman. I’m a blonde, and the stakes are higher for attacking a blonde.
      Is he over the income limits for a public hospital? Do you have a big religious medical complex nearby where you can send him? Where I live the church hospitals have public clinics to work with the uninsured. Then I think they can rotate their own specialists into the clinic.

    • Michael Rack

      “I am his friend, not his doctor” You are his doctor now- In most jurisdictions your actions would have created a doctor-patient relationship.

      • querywoman

        Absolutely! She is now his doctor as well as a friend.

  • PamelaWibleMD

    Who are you? Hispanic physician in Oregon. Hmmmm. . .

  • John C. Key MD

    You guys make Eugene sound like a pretty rough place!

  • Myron Shank

    Did you consider post-traumatic stress disorder as an explanation both for his emotional/behavioral reactions and his blood pressure responses? It sounds like he has more than adequate reason to have it. “Racism” is neither a medical condition nor treatable, but post-traumatic stress disorder is both. Dismissing his blood pressure as due to one untreatable “diagnosis” is no more scientific or helpful to him than dismissing it as due to another. Myron Shank, M.D., Ph.D.

    • PamelaWibleMD

      Yes. PTSD is certainly part of this, I’d say.
      Question is what caused his PTSD? Maybe racism.

      Always trying to get to the root of the problem.

  • PamelaWibleMD

    But they can lower their BP, HR, RR, and body temperature pretty effectively w/o drugs. Wish they would teach us how to do that in med school. :)

    • querywoman

      Antihypertensives are the most sacred of current American medical holy cows.
      I was very critical of doctors when I was younger who wanted to play with the BP cuff but couldn’t do anything else.
      Many doctors are terrified of a slightly high BP reading but can’t do squat for something with symptoms.

      When I really started going into diabetes, I got a pounding heart.
      Now I do take them.
      But generations have lived and died on this earth without the blood pressure cuff.
      All Buddhists die too.

  • PamelaWibleMD

    Damien is not a man who wants to be a victim. People need to understand that racism (subtle and not so subtle) continues to impact the lives of our brothers and sisters.Why deny it? Why not define the source of our patients’ problems? How can we ever really help patients if we are resistant to identifying the true source of their ailments?

  • DoubtfulGuest

    4th day of this song being stuck in my head, darn it.

  • querywoman

    Nobody’s ever convinced me that the hypertension industry is more than hyperbole and conjecture anyway.
    Lots of people go without seeing a doctor for years and walk into a doctor’s office for some reason and the doctor says they have dangerously high blood pressure and demand that they start consuming certain chemicals ASAP.
    I have been researching epidemics in indigenous populations. The blood pressure cuff is the least of concerns when these people get sick.
    So why does an illness without symptoms get all this attention?
    I’ve been to umpteen doctors who don’t care about illnesses without symptoms. I ask that such doctors put a sign on the doors that states, “I specialize in preventive medicine. I do not treat sick people,”
    I don’t have the time or money to waste on doctors who don’t treat sick people.

  • querywoman

    There’s nothing wrong with a hoodie, just like there’s nothing wrong with alcohol or opium.
    I don’t think that an occasional cigarette is that. My mother was a champion smoker, and lung cancer put her lights out. But not every smoker dies of a smoking-related illness! Many live long lives.

  • JR

    Found an interesting article among troops that showed those that witnessed death were at a higher risk for hypertension that you might like to read:

    http://www.medpagetoday.com/Cardiology/Hypertension/15951

    So if you are suggesting that high blood pressure among minorities may be due to the violence they experience and not genetics, and that some of that violence is due to racism, I agree with that conclusion.