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Abstract

Uncontrolled hypertension remains a major public health problem among African Americans. Pilot data for the newly launched Dallas Heart Disease Prevention Project led us to hypothesize that among urban African Americans there exists a high prevalence of lay beliefs about the causes and consequences of high blood pressure that diverge sharply from the current medical approach to hypertension. We analyzed the initial data from our on-going random household survey of non-Hispanic black (n=459) and white (n=258) residents of Dallas County. At the time of this analysis, the sample consists of 420 women and 297 men. The prevalence of hypertension is 35% among blacks and 27% among whites. We constructed scales pertaining to perceived causes and treatment of hypertension and its symptoms. Our major preliminary findings are two-fold. First, certain beliefs about the causes and treatment of hypertension are much more prevalent among blacks (73%-96%) than among whites (39%-77%). In particular, blacks are more likely than whites to believe that hypertension occurs when the blood travels too fast to the head, is caused by eating too much pork, and can be effectively treated with alternative remedies including garlic, bitters that thin the blood, herbs, and prayer. Our univariate logistic regression model revealed that blacks are 12.7 times more likely than whites to hold these beliefs (95% confidence interval=8.0-20.2; p<0.001). After adjusting for gender, age, income, education, marital status, and hypertension, the dramatic odds ratio persisted (odds ratio=9.2, 95% confidence interval=5.5-15.4, p<.001). Additional predictors of these lay beliefs included: female gender (odds ratio=1.6, 95% confidence interval=1.1-2.5, p=.02); low income (odds ratio=2.2, 95% confidence interval=1.2-4.2, p=.01); and lower level of education (odds ratio=1.8, 95% confidence interval=1.1-2.8, p=.01). The second major finding is that, regardless of ethnicity, only a small fraction of the respondents believe that hypertension is asymptomatic [14% of blacks (and 15% of whites)]. The majority of both blacks and whites believe that hypertension is universally accompanied by headaches, flushing, dizziness, rapid heart beat, or fainting. Taken together, these preliminary data indicate that non-medical beliefs about hypertension are pervasive among African Americans in Dallas County. Such beliefs may constitute an important, but previously unappreciated, barrier to improving hypertension control in the high-risk African American community.

African Americans, lay beliefs, hypertension
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© American Journal of Hypertension, Ltd. 2001
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