Puerto Rico, High Blood Pressure, And Skin Color

Puerto Rico, High Blood Pressure, And Skin Color

Black people all over the Americas no matter what country they are found in have higher blood pressures disproportionately for their numbers. They have higher blood pressure than members of other ethnic groups. Some say it is genetic, but new research says that it possibly is more than likely the result of culturally institutionalized social racism that is interwoven throughout those countries where black people live.       

Researchers went to Puerto Rico and did a study on how High blood pressure varies across skin complexion lines. The research was set in Guayama, Puerto Rico, a southeastern coastal town of approximately 44 000 residents. In Puerto Rico there are three major racial classifications Blanco meaning white, Negro meaning black and Trigueno meaning the mixed looking people. Trigueno literally means the color of wheat, and it is applied to people who don’t look white or black — they are mixed race in physical appearance, and these mixed race looking people have various mixed phenotypes (physical appearances). Basically even though they are all called Trigueno there are many different combinational looks among them.   

Researchers discovered that dark skin black Puerto Ricans had higher blood pressure than white and Trigueno Puerto Ricans, and also discovered that the high blood pressure was not genetically based. Some medical Doctors and researchers in the United States have propagated that due to genetic factors — people who have black African ancestry naturally are more prone to develop high blood pressure — because they have black ancestry or are mixed with black.   

Researchers Clarence C. Gravlee, William W. Dressler, and H. Russell Bernard based upon their research in Puerto Rico believe that sociocultural processes mediate the link between skin color and blood pressure. In other words due to socially institutionalized racism against people who are considered black– because of their skin color is the major reason for black Puerto Ricans having a higher blood pressure rate.   

Their high blood pressure rate is not because they were born black. The study shows that the white Puerto Ricans have the lowest blood pressure, then the Trigueno population, and the black Puerto Ricans have the highest. Being a Trigueno puts the person between black and white, and therefore, allows Triguenos to be more fluid (mobile) in Puerto Rican society. The majority of Triguenos are mixed with black, white, and Native Tanio Indian (Arawak). Some of them are mixed with black, white, Tanio Indian and other ethnicities also.    

These mixtures allow the mixed race people to feel comfortable associating with white and black Puerto Ricans. In return many white and black Puerto Ricans feel comfortable associating with the mixed race people (Trigueno). Do to their being an intermediate group called Trigueno this is the major reason that the mixed race people suffer less social racial discrimination, and thus having a lower blood pressure rate than black Puerto Ricans.      

Mixed Race People In America 

In the Untied States of America currently if you have black ancestry that is visible in your phenotype (physical appearance) you are considered black (African American). The reason for this is because of two racist pathologies called the One drop rule (ODR) and hypodescent. The one drop rule says that if you have one drop of black blood then you are black, even if your physical body shows no visible signs of black ancestry. Basically because you have some or a black ancestor, or one black parent, this makes you black.

Hypodescent is the practice of determining the lineage of a child of mixed race ancestry by assigning the child to the race of his or her more socially subordinate parent. If one parent is white and the other is black then the child will be considered black — even when that child marries another person. These two racial pathologies are genetically and medically scientifically inaccurate. The two racial pathologies were left over from Slavery and Jim Crow eras of American history. In 1967, the Supreme removed Court anti miscegenation laws, and also, removed the one drop rule (ODR) from the law books of all states that still had these two laws in effect. The ODR and hypo descent are only applied by way of social tradition meaning that many black, white, and other ethnic groups continue to follow the tradition that if a person has visible or invisible but especially visible black ancestry that person is seen as an African American (black).

The mixed race people of America who have some black ancestry but don’t have black phenotypes have high blood pressure, and their blood pressure is just as high as any black person regardless of skin color. Yet the mixed race people (Trigueno) of Puerto Rico have lower blood pressures. Both the mixed race African Americans and mixed race Puerto Ricans are mixed with black, white, and Native Indian ancestries.

The difference is, that in Puerto Rico the Trigueno (mixed race) are not labeled black, and therefore, do not have to deal with the same amount of racism that black Puerto Ricans have to deal with. Wherefore, in America the mixed race people who have some visible black ancestry are labeled black, and therefore, experience the same type of racism that black Americans experience. If there was a government recognized third category that would separate mixed race African Americans who don’t have sub Saharan African phenotypes from African Americans who have sub Saharan African phenotypes, and this category would become socially accepted by society then the mixed race people would eventually have a lower blood pressures. While African Americans who have phenotypes that look more sub Saharan African would continue to have high blood pressures as long as they are more socially discriminated against by general American society. 

So the major culprit is social racism of Puerto Rico and America against black people that is responsible for the High blood pressures.                    

Copyright American Journal of Public Health 2005

Skin Color, Social Classification, and Blood Pressure in Southeastern Puerto Rico

The Researchers Clarence C. Gravlee is with the Department of Anthropology, Florida State University, Tallahassee. William W. Dressler is with the Department of Anthropology, University of Alabama, Tuscaloosa. H. Russell Bernard is with the Department of Anthropology, University of Florida, Gainesville



The Objectives. We tested competing hypotheses for the skin color–blood pressure relationship by analyzing the association between blood pressure and 2 skin color variables: skin pigmentation and social classification.
Methods. We measured skin pigmentation by reflectance spectrophotometry and social classification by linking respondents to ethnographic data on the cultural model of “color” in southeastern Puerto Rico. We used multiple regression analysis to test the associations between these variables and blood pressure in a community-based sample of Puerto Rican adults aged 25–55 years (n=100). Regression models included age, gender, body mass index (BMI), self-reported use of antihypertensive medication, and socioeconomic status (SES).

Results. Social classification, but not skin pigmentation, is associated with systolic and diastolic blood pressure through a statistical interaction with SES, independent of age, gender, BMI, self-reported use of antihypertensive medication, and skin reflectance.

Conclusion. Our findings suggest that sociocultural processes mediate the relationship between skin color and blood pressure. They also help to clarify the meaning and measurement of skin color and “race” as social variables in health research.
There remains no consensus as to why this pattern exists, leading some to call it “the puzzle of hypertension in African-Americans.”8 One key piece of the puzzle is that, within populations of African ancestry, darker-skinned individuals tend to have higher mean blood pressures than do their lighter-skinned counterparts. Previous researchers have proposed 2 major explanations for this relationship. The first is that dark skin color, as a marker of African ancestry, is linked to a genetic predisposition for high blood pressure.9,10 The second is that dark skin color, as a marker of subordinate social status, exposes dark-skinned individuals to racial discrimination, poverty, and other stressors related to blood pressure.11–13 These competing hypotheses—1 genetic, 1 sociocultural—encapsulate the debate over race and health in general, making the skin color–blood pressure relationship a convenient microcosm of the broader problem.

Our purpose was to test competing explanations for the relationship between skin color and blood pressure more directly than has been done before. We address an important limitation of previous studies by recognizing that genetic and sociocultural hypotheses refer to distinct dimensions of skin color. The hypothesis that skin color is linked to a genetic predisposition for high blood pressure refers to the phenotype of skin pigmentation. The hypothesis that skin color is a marker of exposure to social stressors refers to the cultural significance of skin color as a criterion of social classification. These conceptually distinct variables require distinct measurement operations. However, previous studies have not aimed to isolate the cultural and biological dimensions of skin color or to test their associations with blood pressure.


We argue that genetic and sociocultural hypotheses for the relationship between skin color and blood pressure entail 2 distinct skin color variables: the phenotype of skin pigmentation and the cultural significance of skin color as a criterion of social classification. Our measurement strategy operationalizes this distinction, and results suggest that the cultural rather than biological dimension of skin color may be the key variable of interest.
Among respondents who are at or above mean SES, those who are culturally defined as negro, or Black, have higher SBP and DBP, on average, than do those classified as blanco, White, or trigueño, Intermediate. This relationship holds independent of age, gender, body mass, skin pigmentation, or reported use of antihypertensive medication. We found no evidence of darker skin pigmentation being associated with higher blood pressure in this sample.

The nature of the relationship between ascribed color and blood pressure is consistent with the ethnographic record in Puerto Rico. First, the interaction between color and SES corresponds to ethnographic evidence that status distinctions based on color are relatively insignificant in low-SES contexts, and that racism is most pernicious in the middle and upper classes.28–31 Thus, respondents who are classified as negro in high-SES contexts may experience more frequent, frustrating social interactions as a result of institutional and interpersonal discrimination. Experimental and observational studies suggest that chronic exposure to such interactions may be linked to cardiovascular responses, including sustained high blood pressure.32,33
Second, the absence of statistically significant differences in blood pressure between the categories trigueño and blanco is consistent with ethnographic evidence. One notable feature of ethnic classification in Puerto Rico, as opposed to the mainland United States, is the existence of intermediate categories, such as trigueño, that do not carry the stigma of “Blackness.” Whereas people defined as negro are likely to encounter institutional and interpersonal constraints on social mobility, those defined as trigueño face relatively few such constraints as a consequence of color.30,31 The finding that high-SES respondents estimated to be negro but not trigueño have the highest blood pressures is therefore consistent with the hypothesis that sociocultural processes mediate the link between skin color and blood pressure.

Despite speculation about possible genetic links between skin color and blood pressure,9,10 it should not be surprising that skin pigmentation and blood pressure are not significantly associated in our sample. Recent studies show that skin pigmentation is associated with molecular estimates of continental ancestry, with correlations ranging from weak (Mexico, ? =.21) to moderately strong (Puerto Rico, ? =.63) across populations.34 Yet the central question is whether continental ancestry is informative about alleles related to blood pressure. Available evidence suggests that it is not.35,36 Skin pigmentation is informative about continental ancestry precisely because its distribution differs from most human genetic variation. Most genetic markers show relatively small differences between human populations,37 but skin pigmentation shows marked regional variation in response to geographic differences in the intensity of ultraviolet radiation.38 Our findings thus reinforce criticism that skin color should not be used uncritically as a marker of racial–genetic predisposition to disease; genetic hypotheses require genetic data.34

Our findings also relate to recent discussions about causal inference and the measurement of “race” as a cultural construct in social epidemiology. Kaufman and Cooper39 suggest that standard comparisons of racially defined groups are ill suited to explaining racial differences in health. In particular, they point out that causal reasoning in epidemiology is based on a counterfactual framework that asks, “What would the outcome have been if the exposed individual were not exposed to the alleged cause?” When the alleged cause is race, they argue, this model breaks down, because there is no logical counterfactual state: “a Black person who is not Black cannot be considered the same person.”39(p115)

Yet, as others have noted,40,41 the constraint on this counterfactual state is empirical, not logical. To imagine a Black person who is not Black, it is necessary only to distinguish between 2 exposures: having dark skin and being culturally defined as “Black.” It is difficult to operationalize this distinction in the mainland United States, because the prevailing cultural model of racial classification defines dark-skinned people with any detectable trace of African ancestry as “Black.” However, as the Puerto Rican case shows, the relative salience of skin color as a basis of social classification is variable across societies, such that people with a given skin tone may be assigned to different folk ethnoracial categories in everyday social interaction.

A key innovation of our study is the attempt to estimate how survey respondents would be classified in everyday social interaction by linking survey measurement to ethnographic data on the salient cultural model of color.19 This strategy treats the notion that race is a cultural construct as a mandate for research. Some well-meaning commentators argue that, because race is a cultural construct and not a biological reality, public health researchers should abandon it as a variable. For example, Fullilove asks, “Why continue to accept something that is not only without biological merit but also full of evil social import?”42(p1297) We suggest that this question contains the answer. Because racial classification in the United States—and other folk classification schemes in other societies—are full of evil social import, social scientists must devise strategies to operationalize racial classification as a sociocultural variable. Our approach to this problem complements other strategies to explain racial health inequalities, including what Krieger40 identifies as the direct and indirect impacts of racism on health.

Perhaps because research on skin color and blood pressure often reflects the assumptions of a racialized worldview,43 previous studies have not distinguished between skin pigmentation and the cultural significance of skin color as potentially independent predictors of blood pressure. However, once we recognize that distinction, existing evidence favors the cultural rather than biological significance of skin color. Seven previous studies of skin color and blood pressure7,9,44–48 measured skin pigmentation with reflectance spectrophotometry; none reported an association between pigmentation and blood pressure in the entire sample after control for age, gender, and SES. One of these studies found an association only in low-SES respondents,46 whereas another reported an association only in Egyptian women.48 By contrast, 5 studies16,49–52 that measured skin color by observer ratings reported a consistent association between skin color and blood pressure across the sample. Thus, studies that measure skin pigmentation precisely using reflectance spectrophotometry provide the weakest evidence for an association between skin color and blood pressure. Those that approximate social classification with observer ratings provide the strongest evidence of such an association.

This set of findings underscores the importance of our measurement approach. However, limitations of the research design moderate the strength of our results. First, by comparison to previous studies, our sample is small. It is noteworthy that, despite the small sample size, we observed a statistically significant relationship between ascribed color and blood pressure. Case diagnostics also indicate that this relationship does not depend on a small number of unusual cases. Still, it remains to be seen whether our findings can be replicated in other parts of Puerto Rico or elsewhere. A larger sample would also increase the statistical power to detect more complex interactions between SES, color, and other important factors, such as gender, perceived discrimination, or access to health care. Second, although our measure of ascribed color is linked to ethnographic data regarding the salient cultural model, it is unclear how well it estimates everyday social classification.

This unresolved question is a critical area for future research. One important extension of this work would be to examine whether nonbiological markers of social status influence the ascription of color and, if so, how this effect alters the association with blood pressure. Third, we did not collect data on dietary intake or energy expenditure. There is evidence that both skin color and exposure to social stressors are associated with blood pressure, independent of such measures,16,21 but attention to nutritional status and physical activity would enhance future research. Fourth, the biological significance of skin pigmentation may differ in Puerto Rico and the mainland United States, given different historical processes of admixture. This difference limits direct comparability between Puerto Rico and the mainland. However, the fact that skin color and blood pressure are related in societies with different histories of genetic admixture, but with common histories of slavery and racial discrimination, suggests that nongenetic factors may provide a more parsimonious explanation.

Given these limitations, our study is significant, more for the questions it raises than for the answers it provides. Skin pigmentation is central to debates about race and genetics, but most researchers fail to distinguish its significance as a biological parameter from its significance as a marker of social status and exposure to stressors.34 Our measurement strategy provides one way to make this distinction explicit. Our finding that blood pressure is associated with culturally ascribed color—but not with skin pigmentation—does not exclude a genetic basis to population differences in blood pressure. Yet it does cast doubt on genetic explanations for the relationship between skin color and blood pressure. This finding highlights the need for testable hypotheses and appropriate measurement operations in future research on the causes of poor health in the African Diaspora.


    The Racial and Ethnic classification of Americans is nothing more than institutionalized racism and must be ended. The United States of America has been known as a country of rugged individualism based on individual freedom and liberty. Why has America become a country obsessed with classifying its citizens into different racial and ethnic sub-groups?

    The only groups that actively support the continued collection of racial and ethnic data are big government bureaucrats and “racial and ethnic special interest groups” that also happen to receive significant funding from the federal government. These organizations argue that identifying people by race and ethnicity is necessary in order to redress some past injustice and that the federal government must continue to collect and use this information in order to set up special racial and ethnic programs, affirmative action quotas and other set-asides for these groups, some of whom consist of new immigrants, illegal aliens and non-citizens. Nothing can be further from the truth. In a country where we can no longer ask people what religion they are, what their party affiliation is or what their sexual orientation is, why are we still asking them about their racial and ethnic background?

    Americans are beginning to realize that racial and ethnic identification is more a matter of personal choice than anything else. In the 2000 Census, seven million American citizens refused to place themselves into a single category by refusing to describe themselves as only white, black, Asian, Latino or any one of the other specific categories listed, because they were of mixed race. Attempts by the government to create a “mixed race” box for the 2000 Census was met with resistance by racial and ethnic special interest groups like the NAACP and the National Council of La Raza, because they feared that a mixed-race box could pose a danger to the justification for their existence. The fuzzier such racial and ethnic categories become, the harder it will be for these racial and ethnic special interest groups and the government to traffic in them. If a mixed-race category were to be added, every brown-skinned person of mixed race registered in this category would shrink the government’s official count of Blacks, Latinos, Asians or American Indians, eventually reducing their political influence and ultimately the amount of money these groups receive from the federal government, which amounts to approximately $185 billion a year.

    Through the mandated collection and use of racial and ethnic specific information, more and more of American taxpayers’ hard earned money is being routinely distributed to these racial and ethnic special interest groups at the expense of all other Americans who may or may not be members of these groups. Through executive orders, congressional legislation, affirmative action programs, racial set-asides, quotas and other programs based solely on race and ethnicity, our federal government is playing the key role that pits one racial and ethnic group against another, which could eventually lead to our destruction as a country.

    Rather than helping a diverse population become assimilated and united as one nation, the Federal government is doing what the Nazi government of Germany did in the 1930’s and 40’s; creating government supported institutionalized racism by the intentional classification of it’s citizens by race and ethnicity.

    With the support of racial and ethnic special interest groups, our federal government seems to view our citizens not just as Americans, but rather as “pawns” in some social science experiment to be classified and separated into different racial or ethnic sub-groups for some unknown purpose. By mandating the classification of Americans into specific racial and ethnic sub-groups, the federal government and the advocates of “diversity” are actually perpetuating institutionalized racism and keeping Americans divided. Maybe the real purpose of collecting this data is to justify the continuing flow of government money to these racial and ethnic special interest groups.

    If we want to help poor Americans escape poverty, get better health care, find a job or get a good education, why should it matter what their race or ethnic background is? The answer is: It should not! Americans need to come together as members of one country and remember that we are all individual Americans, regardless of race or ethnic background. Martin Luther King, Jr., inspired a nation when he voiced his dream for a color-blind nation, a nation in which people would be judged by the content of their characters, “not the color of their skin.” The answer to this government encouraged racism is the concept of Liberty with a limited, constitutional government that is devoted to the protection of individual rights rather than the claims of different racial and ethnic special interest groups. Where Liberty is present, individual achievement and competence are rewarded, not people’s skin color or ethnicity.

    I will support legislation barring the federal government from the collection of racial and ethnic information about the American people and/or the classification of American citizens by race and ethnicity, including the collection of census information. Exceptions should be made for law enforcement, hospitals and medical research purposes.

    I will also support legislation that bans affirmative action programs, racial set-asides, quotas and any other programs that give special preferences based on race and ethnicity.

    Candidate for Congress
    New York’s 20th Congressional District

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