Statistics show that a significantly higher number of Black Americans have high blood pressure compared to other groups and populations that have not been historically marginalized. This has implications for both the prevalence of hypertension and its treatment.
Hypertension is a serious issue that can lead to many critical conditions, and in this article, we’ll break down the causes and implications of hypertension in the Black community and provide some tips on managing and potentially improving this disparity.
Is hypertension in African Americans disproportionate?
According to the American Heart Association (AHA), around 55% of Black adults in the United States have hypertension. In contrast, non-Hispanic white adults have a rate of 48%, non-Hispanic Asian adults have a rate of 46%, and Hispanic adults have a rate of 39%.
The Centers for Disease Control and Prevention (CDC) states that the overall prevalence of high blood pressure among non-Hispanic Black men and women is over 50%, which is higher than any other ethnic group.
The American College of Cardiology associates the higher prevalence of hypertension in the Black community with higher stroke rates, end-stage renal disease, and congestive heart failure.
Additionally, according to the Department of Health and Human Services Office of Minority Health, in 2019, African Americans were 30% more likely to die from heart disease than non-Hispanic white people.
Overall, Black Americans have a significantly lower life expectancy than white Americans due to these increased risks associated with high blood pressure, as well as mismanagement of high blood pressure through historical healthcare racism and inequity.
Environmental and biological risk factors
A variety of risk factors can affect the chances of hypertension. Potential risk factors in all ethnic populations include:
- reduced physical activity
- family history
- advancing age
- obesity
- a high (sodium) salt diet
- increased alcohol consumption
- a diet with a high fat content
- not getting enough potassium
Historical oppression, racism, and discrimination of Black communities have resulted in economic disparities, inadequate healthcare, poor living conditions, and lack of access to nutritious food.
These circumstances are the reason why a high percentage of Black Americans have hypertension. Other factors contributing to high blood pressure in the Black community include genetics, additional environmental factors, and habits.
Genetic differences
An older 2011 study found that 18 genotypes and intermediate phenotypes may be responsible for increased blood pressure in Black American populations, including higher sensitivity to the effects of alcohol.
Additionally, the way that Black American populations metabolize and process salt (sodium) seems to play a role in the likelihood of developing high blood pressure.
Bias and systemic inequality
Healthcare disparity still exists in managing and treating hypertension and other conditions in Black Americans. For example, Black Americans continue to have higher morbidity and mortality rates than white Americans for most indicators of physical health.
Compared with white people, Black people and other historically marginalized communities have lower access to medical care due to higher unemployment rates and a general under-representation in well-paying jobs with healthcare benefits. To demonstrate this point, in 2017, 10.6% of Black and Asian people were uninsured, compared with 5.9% of non-Hispanic white populations.
Hypertension treatment
Several treatment options are available to manage hypertension, depending on the severity, stage, and your specific healthcare needs.
Medication
Some researchers believe calcium channel blockers and diuretics are particularly effective for treating hypertension in Black Americans because of their influence on sodium levels.
A 2018 review states that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are not often as successful in Black patients, and healthcare professionals are advised not to prescribe them as the only form of hypertension treatment.
But medication is often the first line of treatment for hypertension, and a healthcare professional may prescribe several drug types, including:
- calcium channel blockers, like amlodipine (Norvasc)
- thiazide diuretics, like chlorthalidone (Thalitone)
- loop diuretics, like furosemide (Lasix)
- beta-blockers, like bisoprolol (Cardicor or Emicor)
- blood vessel dilators, like hydralazine (Apresoline) and minoxidil
Oral therapies, including nitroprusside sodium (Nitropress), can quickly lower blood pressure in an urgent situation. Your doctor will explain how to use this medication when prescribing it.
Lifestyle adaptations
Lifestyle adaptations can also be effective in managing hypertension, including:
- following a nutritious diet
- reducing salt intake
- maintaining a moderate weight
- exercising regularly
- limiting alcohol intake (If you drink)
- quitting smoking (If you smoke)
Making these changes can help lower blood pressure and reduce the risk of associated health conditions.
Treating hypertensive emergencies
In some cases, hypertension can reach dangerous levels and require immediate medical attention. Hypertensive emergencies happen when blood pressure is extremely high, and there is a risk of organ damage.
In such cases, it is essential to seek medical attention right away. A healthcare team will typically give you intravenous (IV) medications to manage the emergency.
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