The slavery hypertension hypothesis: dissemination and appeal of a modern race theory

Abstract

In this essay we present a case study of a recent etiologic hypothesis that was advanced in an effort to explain observed racial/ethnic variation in hypertension prevalence. We trace the historical development of this hypothesis, from early statements to current expressions. We examine the debate that has transpired in scientific journals and been disseminated through medical textbooks and the popular press, and the relation of these arguments to putative evidence from population genetics, historical demography and other fields. Despite criticism, this hypothesis has sustained some considerable degree of popular and scientific acceptance. We discuss this phenomenon in relation to broader themes in the epidemiology of racial/ethnic disparities. These include the use and misuse of various types of data, the role of peer review and its potential deficiencies in evaluating extradisciplinary material, and the ways in which popular notions about “race” contribute to epidemiologists’ credulity in the case of a controvertible hypothesis. Hypertension in African-Americans Observations of an African-American excess in mean blood pressure or in clinically diagnosed hypertension arose over a century ago, with primitive survey results dating back to at least as early as 1932. 1 By the 1960s there was extensive evidence from population-based surveys to indicate that black Americans experienced nearly twice the level of clinically defined hypertension observed among white Americans. 2 Altho…