Discrimination and Hypertension among a Diverse Sample of Racial and Sexual Minority Men Living with HIV: Baseline Findings of a Longitudinal Cohort Study

Abstract

Racial and sexual orientation discrimination may exacerbate the double epidemic of hypertension and HIV that affects men of color who have sex with men (MSM). This was a cross-sectional analysis of African American, Asian American, Native Hawaiian or Pacific Islander (NHPI) MSM living with HIV (PLWH) cohort in Honolulu and Philadelphia. Racial and sexual orientation discrimination, stress, anxiety, and depression was measured with computer assisted self-interview questionnaires (CASI). We examined the associations between racial and sexual orientation discrimination with hypertension measured both in the office and by 24-hour ambulatory blood pressure monitoring (ABPM) using multivariable logistic regression. Sixty participants (60% African American, 18% Asian, and 22% NHPI) completed CASIs and 24-hour ABPM. African American participants (80%) reported more daily racial discrimination than Asian American (36%) and NHPI participants (17%, p < 0.001). Many participants (51%) reported daily sexual orientation discrimination. Sixty-six percent of participants had hypertension by office measurement and 59% had hypertension by 24-hour ABPM measurement. Participants who experienced racial discrimination had greater odds of having office-measured hypertension than those who did not, even after adjustment (Odds Ratio 5.1 (95% Confidence Interval [1.2–20.1], p = 0.01). This association was not seen with 24-hour ABPM. Hypertension was not associated with sexual orientation discrimination. In this cohort, MSM of color PLWH experience significant amounts of discrimination and hypertension. Those who experienced racial discrimination had higher in-office blood pressure. This difference was not observed in 24-hour APBM and future research is necessary to examine the long term cardiovascular effects.