Health Promotion And Appropriate Treatment For Black Women With High Blood Pressure

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Hypertension is a common health problem that affects 1 in 3 adults (32.6%) in the United States.1 However, hypertension is not evenly distributed in the American population; the incidence of hypertension is disproportionately higher among black Americans than among white Americans, affecting 42% of black men and 44% of black women.2

The prevalence of hypertension and cardiovascular disease in black women is particularly high.3 Compared to white women, black women are 60% more likely to have high blood pressure.4 Black women are also more likely to be diagnosed with hypertension at a younger age, have higher blood pressure readings, and die from hypertension complications earlier than white women.5.6 In 2017, black men and women were 20% more likely to die from heart disease than non-Hispanic white patients.4

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Despite the availability of effective drugs and therapies tailored to black patients, disease management is less effective in black patients than in white patients, resulting in higher death rates.1-7 In a study by Jamerson et al, black women were less likely than white women to achieve blood pressure control. After 5 years, 59% of black women and 65% of white women had blood pressure below 140/90 mm

Risk factors for hypertension in black women

The high rate of hypertension in black women stems from biological, genetic, environmental and social factors. Biological factors associated with an increased risk of hypertension include aortic stiffness, vascular remodeling, and endothelial dysfunction.8 An important biological factor concerns the stress response. Hypertension in black women results, in part, from increased vascular adrenergic responsiveness and reduced vasodilator responses to stress. The body activates its hypertensive stress response more often and keeps the vessels contracted longer in black women than in non-black women.8

Patients may have a genetic predisposition to this biological response. Several genes involved in the activation of the renin-angiotensin-aldosterone system (RAAS) have been studied in black populations and have revealed a surprising number of new variants and pathways potentially involved in the pathogenesis of hypertension. Among them, a variant of the repeating armadillo containing 5 (ARMC5) appears to be a rare hereditary cause of primary aldosteronism and, consequently, of low renin hypertension in black individuals.9

Environmental factors that contribute to hypertension include limited physical activity, smoking, alcohol use, and institutional racism.4 Other causes of hypertension in black men and women include diet, particularly a Southern diet, defined in the REGARDS study as high consumption of fried foods, offal, processed meats, meals. made from eggs and eggs, added fats, high fat dairy products, sugary drinks and bread.10.11

The Southern diet has been linked to an increased risk of stroke, coronary heart disease, end-stage kidney disease, chronic kidney disease, sepsis, fatal cancer, and cognitive decline.12-16 The Southern diet as well as a high sodium to potassium dietary ratio have been shown to mediate the difference in stroke risk between blacks and whites. Less adherence to dietary approaches to stop hypertension diet (DASH) (low-fat vegetables, fruits and dairy products) was an important mediating factor in black and white women.11

In 2018, Howard et al found that black women have a higher average BMI and waist circumference than white women, and that both waist circumference and BMI are significantly associated with incident hypertension. .ten In black women, BMI was the second most important mediating factor for hypertension and a larger waist circumference was the third most important. The prevalence of obesity among black women has doubled over the past two decades.17

The higher incidence of hypertension in black women has been linked to social factors such as low income (≤ $ 35,000) and level of education (high school diploma or less).ten Lower socioeconomic status may be associated with living in a very stressful or isolated environment with higher crime rates and more marital divisions, which has been linked to increased blood pressure in black people.8.18 Still et al found that black women often take on the role of caregiver for older family members and children, as well as the home, which increases their vulnerability to psychological stressors.18

A number of studies have focused on the societal factor of minority stress and its association with health outcomes. Racial discrimination and stressors associated with minority status have been associated with hypertension and increased cardiometabolic health risks in black women.19-22

From the January / February 2021 issue of Clinical Advisor

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