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The Slavery Hypertension Hypothesis proposed by Wilson and Grim claims that African Americans possess genetic predisposition for life-threatening elevated blood pressure that was the consequence of intense selection during the Middle Passage and the period of enslavement. The biological changes resulted from a genetic bottleneck that was marked by mechanisms that conserved salt in those who survived infectious diseases causing diarrhea and vomiting. The hypothesis has gained prominence in the popular press, frequently cited in peer-reviewed articles and featured in medical textbooks that offer little genetic evidence to support the hypothesis. There is no indication of a genetic bottleneck or evidence of "racial" differences that are genetically determined. It is time to discard the myth of the Slavery Hypertension Hypothesis and begin to examine the issue from a biological and social perspective that reflects a more realistic approach to the disparities that exist in the prevalence of hypertension.
KEYWORDS: enslavement, hypertension, Middle Passage, salt conservation, genetic predisposition
Hypertension remains one of America's most pressing health problems. The prevalence of hypertension among African Americans contributes to significant ethnic health disparities in the United States. Hypertension is the single greatest factor leading to cardiovascular disease in African Americans (Nesbitt and Victor 2004:24). Premature excess cardiovascular disease (defined as occurring prior to age 65) is a pattern in African Americans. The end-organ consequences of hypertension result in a higher incidence of stroke, increased renal disease that often leads to end-stage renal disease, greater risk of left ventricular hypertrophy, and higher risk of heart failure (Nesbitt and Victor 2004:24). African American women, when compared to "White" women, have twice the number of "productive years lost" (Nesbitt and Victor 2004:24). African American men experience a fourfold greater loss of "productive years" (Nesbitt and Victor 2004:24).
Hypertension in Blacks remains "a puzzle to be solved" (Cooper 1991), and the sodium sensitivity and psychosocial stress hypotheses, the two most prominent hypotheses, are "not wholly convincing" (Cooper 1991:112). A genetic propensity for salt retention (De Wardener and MacGregor 2002; Gleiberman 1973; Kurokawa 2001; Palacios et al. 2004; Taubes 1998; Wright et al. 2003) has been suspected in hypertension in African Americans but not proven (Aviv et al. 2004; Forrester 2004; Joossens and Geboers 1983; Kurokawa 2001; Kurokawa and Okuda 1998; O'Shaughnessy and...