by Ayotola Ogunsipe

Fact-checked by Christopher M. Cirino, DO MPH

Introduction

Hypertension is a condition that affects more than one-third of Americans, and if you are African-American, the prevalence is much higher. It is estimated that 40 percent of the black population have high blood pressure with the effect of the condition known to be more devastating within this group. 

Several studies establish racial disparities in hypertension and hypertension-related outcomes, blacks with more severity compared to their white counterparts, Some researchers have linked the higher prevalence to racial discrimination and limited health care access. Others hypothesize a salt-sensitivity gene is responsible for this higher prevalence of hypertension in African Americans.

However, it is not enough to ascertain factors that may be responsible for the disproportionate occurrence of hypertension in blacks; there is also the need to create awareness on how to prevent, reduce or treat this condition. One way to achieve this is to identify the risk factors that can be controlled to reduce an individual’s chances of developing hypertension. 

In this post, we will focus on the risk factors responsible for this higher prevalence but first, let’s take a look at how hypertension is diagnosed.

Diagnosis

How do you detect hypertension when you can barely see or feel it? Or do you just assume that your chances of developing hypertension are high because you are black?

Well, just as the saying goes, “if you can’t measure it, you can’t improve it”, hypertension can only be improved when it is measured, and one way to do this is when you visit the doctor’s office. However, it is also recommended that you have a home blood pressure monitor, which allows you to check your BP numbers regularly. In fact, the numbers from your doctor’s office can sometimes be misleading because of the anxiety that precedes the measurement, which could cause a situationally elevated blood pressure (i.e. in the doctor’s office) known as white coat hypetension. 

When taking your blood pressure, note that your blood pressure consists of two numbers. The top number that you see on your screen is the systolic blood pressure, which is the pressure on your blood vessel walls during a heartbeat. On the other hand, the bottom or lower number is the diastolic blood pressure which is the pressure between heartbeats. Your doctor may recommend ambulatory monitoring of your blood pressure, in which blood pressure readings are measures over a period of time outside of the clinic to distinguish white coat hypertension from true hypertension.

When the top number gives a reading of 120-139 and the bottom number is 80-89, your doctor may diagnose you to have prehypertension. Oftentimes, modifying your lifestyle may be sufficient to bring down your blood pressure numbers at this stage. In the recent past, people have often paid more attention to the systolic number, but experts have revealed that the heart can tolerate a high systolic number better than a diastolic number. However, as you grow older, the systolic number is more significant because the risk of heart attack and stroke increases with age.

When the top number is above 140 and the bottom is above 90, your doctor will monitor for some time. If your BP numbers stay elevated, your doctor will diagnose you with hypertension. Medications are usually required to treat it. In some cases, your blood pressure may continue to be high even after starting them. This is often due to the approach to reducing your blood pressure, which may not be holistic. Ideally, treating hypertension should not just be about medications. Instead, managing the condition should involve a mix of counseling, exercise, dietary control among others.

Risk factors

Apart from the inherent genetic components due to an individual’s background or family, many of the risk factors associated with hypertension can be addressed with lifestyle modification, which can significantly reduce your chances of developing hypertension.  

Sedentary lifestyle

From being stuck in a car during your daily commute to sitting behind a desk for long hours, the typical lifestyle of an American worker these days can be termed as sedentary. In fact, physically active jobs currently make up less than 20 percent of the U.S workforce, and within the African American community, the situation is far worse. Blacks are known to have the highest sedentary lifestyle at almost 32% when compared to other groups, and this factor has been identified as one of the key contributors to hypertension. Specifically, people who are less active have a 30 – 50% greater incidence of hypertension than their active peers. 

Diet

Diet is one of the biggest contributors to the high rate of hypertension within the African American community.  In 2018, a study revealed that the traditional Southern diet, a popular ethnic cuisine consumed by African Americans can increase the prevalence rate of high blood pressure. In fact, it is said that African Americans tend to eat as many as five times more southern-style food than other races, which increases their chances of having a stroke by as much as 63%. Comprising deep-fried foods, pecan pies, organ meats, processed meats, dairy, sugar-sweetened beverages, and bread, the Southern diet is high in added fats, salt, and nitrates, which are substances linked to hypertension, and heart disease. Overall, a diet high in fat, salt, and sugar is bad for anyone looking to prevent hypertension

Alcohol

Having more than two drinks in a sitting can raise your blood pressure. However, if you are a social drinker, this may not be a problem because your alcohol consumption is not habitual; consequently, the effect of the substance is often transient. On the other hand, if this pattern of usage happens repeatedly, the body may adapt to this level. There is a possibility that you may start drinking in a manner that exceeds the healthy limits. Consequently, alcohol acts as a toxin and can increase your blood pressure to unhealthy levels. The result is developing hypertension at the very least and a stroke or death in the worst cases.

Interestingly, alcohol consumption is lower within the black community when compared to other racial groups yet blacks are more likely to struggle with the problems relating to alcohol use unlike other groups with one of such being hypertension. 

Obesity

Being overweight or obese has been linked to higher blood pressure levels. In fact, losing weight is by far the most effective way of reducing your blood pressure. One of the major groups affected by weight gain and obesity is African American women. They are said to have the highest rates of obesity or being overweight when compared to other racial groups in America. In a recent study, it was reported that four in five African American women are overweight. Consequently, the problem of obesity-associated hypertension has been steadily increasing in African-American women and it is expected to continue to rise over the next decades if unaddressed.

Age

It is well established that blood pressure rises with age and many people tend not to worry about their blood pressure until they are much older. However, within the African American population, hypertension is not just a growing concern as you get older; as a matter of fact, the racial difference factors culminating in a higher hypertension risk tend to have developed in black adults by age 30.

Furthermore, stroke mortality is two times greater in blacks when compared to their white counterparts of the same age.  A study recently revealed that a 45-year-old African American living in the southeastern US has the same stroke risk of having a stroke as a 55-year-old white man living in the same region as well as a 65-year-old white man in the Midwest. 

Smoking 

Although smoking may not be as prevalent in the black communities when compared to the whites, research has indicated that this racial group is more likely to die from smoking-related diseases than their white counterparts. Cigarette smoking is a well-established causative factor for cardiovascular heart disease (CHD) and it is known to raise blood pressure as a result of the nicotine it contains, which consequently narrows the arteries and hardens their walls due to the formation of plaques. However, it has also been discovered that quitting smoking may reduce the CHD risk in these former smokers to a level comparable with those that have never smoked.

Conclusion

In black communities, one of the major obstacles to identifying the risk factors of hypertension is the limited access to healthcare, which prevents members of the communities from checking their blood pressure numbers regularly. The lack of access to healthcare is usually due to the disparity in public health infrastructure and health insurance coverage when it comes to these communities of color. Combining this with the fact that blacks tend not to trust doctors and are typically poorer than other racial groups, it is highly likely that black adults will miss their checkups and may be unable to nip their high blood pressure in the bud.

If you are an African American, there are ways to prevent hypertension or lower your blood pressure numbers even if you have limited access to healthcare or cannot afford it. For example, reducing your salt-intake can reduce your blood pressure or lower your odds of developing hypertension. You can also learn more about how to overcome hypertension in this post.

Author’s Bio

Ayotola is a pharmacist and researcher with a Master’s in Pharmacology from the University of Lagos.  He is passionate about creating engaging healthcare content that drives his target audience to take action to lead healthier lives. You can reach Ayotola on his website here.