Invited Commentary: Fundamental Causes, Social Context, and Modifiable Risk Factors in the Racial/Ethnic Inequalities in Blood Pressure and Hypertension

Racial and ethnic inequalities in blood pressure and hypertension have been well documented, but their causes remain unclear, making efforts to reduce these inequalities challenging. In this issue of the Journal, Basu et al. (Am J Epidemiol. 2015;182(4):345-353) address this gap in our knowledge by using an econometric approach to examine the role of 4 conventional risk factors for hypertension. Their results suggest that targeting certain risk factors will reduce racial inequalities in the prevalence of hypertension. However, racial differences in modifiable risk factors are enmeshed within disparate socioenvironmental contexts which are in turn determined by inequalities in the distribution of social, economic, and political resources and constraints. A small but growing body of literature suggests that targeting the intermediate risk factors that link racial group membership to hypertension, rather than the context or the inequalities in the distribution of resources and constraints, will ultimately result in little change in hypertension inequalities, increase these inequalities, or even create inequalities in poor mental health.