What you should know about race and hypertension

Odds are good that you either know someone with hypertension or you are someone with hypertension. The condition occurs when your blood pressure, the force of blood pushing against the walls of your veins and arteries, is often elevated. It affects nearly half of all Americans, and the data is worst for Black Americans. Among non-Hispanic Black adults, 54% have high blood pressure (versus 46% of non-Hispanic white adults), and they’re less likely to have an effective treatment plan.

To make matters more complicated, doctors don’t always know how to best treat hypertension in people of color, says Aniya Mercadel, PharmD, a pharmacist who serves a majority-Black American population in Hattiesburg, Mississippi. They often prescribe medications without taking the patient’s race into consideration.

Mercadel chatted with us about the nuances of high blood pressure in the Black American community. Here’s what you should know about the problem and the treatment options.

Q: Why should Black Americans be concerned about high blood pressure?

Mercadel: Hypertension [a blood pressure reading over 130/80] is often called a silent killer. It rarely presents with symptoms, yet if it’s not treated in time, it can lead to serious and sometimes deadly conditions, such as heart attack or stroke. Risk factors for hypertension include diabetes, obesity, tobacco and alcohol use and physical inactivity. But the alarming thing is that being Black is also a risk factor. Black Americans are more sensitive to salt, which increases their chance of developing high blood pressure.

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Q: Why is it harder for Black people to control blood pressure?

Mercadel: Most patients are unaware they have it. Symptoms of high blood pressure [such as headaches and shortness of breath] become “normal.” And when people finally discover the problem, they have a hard time sticking to a medication plan and heart-healthy diet. Physical inactivity along with greasy, fried and salty foods can really set some people back.

Another thing to think about: Many neighborhoods where Black people live are food deserts, meaning there is a lack of access to heart-healthy fresh fruits and vegetables. Prescribers can help their patients by encouraging baking foods instead of frying and using sodium-free seasoning substitutes such as Mrs. Dash [now simply called “Dash”] in place of salt.

Q: What are the most effective treatments for Black Americans? 

Mercadel: Look for calcium channel blockers such as amlodipine. They work by slowing the flow of calcium into muscle cells in the heart and blood vessels. Basically, blocking the calcium helps the arteries and vessels relax and open up. Blood flow increases, and blood pressure decreases.

Q: Are there medications that affect Black people differently?

Mercadel: In some instances, ACE inhibitors [lisinopril, for example] are less effective in people of color. They inhibit the production of angiotensin II, an enzyme that narrows the blood vessels and makes your heart work harder. ACE inhibitors can help blood vessels dilate, but they’re not the best option for Black Americans. They can cause coughing or a type of swelling that usually affects the skin around the eyes and lips.

Side effects such as these can be a big problem. Sometimes they cause patients to discontinue treatment without consulting a health care professional first. That’s why I prefer low-dose amlodipine as a first-line therapy for treating high blood pressure in Black patients. While the medication can still cause side effects such as headache or fatigue, it’s associated with little to no swelling or coughing.

Q: What should Black patients do if the doctor prescribes a treatment they don’t feel is right for them?

Mercadel: Be firm and confident in your beliefs. Don’t hesitate to ask for other options. Your doctor may be aware of how to prescribe medication, but only you know how your body is responding. And if your prescriber doesn’t feel the need to switch, consider getting a second opinion.

Lifestyle changes can have a huge impact on your blood pressure, too. Learn more about everyday habits that make a big difference.

Q: As a pharmacist, what do you feel your role is in helping to treat hypertension?

Mercadel: Pharmacists are responsible for making sure patients know how their medications work. We’re here to answer questions about side effects. If a patient has any issue about their hypertension meds, pharmacists have no problem consulting with the prescriber about a therapy change.

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