As cardiologists and primary care physicians, we encounter patients with hypertension daily, but the impact on Black patients is particularly concerning. Hypertension disproportionately affects the Black community, and its consequences are often more severe. We need to take hypertension much more seriously, especially in our Black patients. Here’s why:
Hypertension is a “silent killer” with a heightened impact on Black patients
Hypertension often has no symptoms, earning it the moniker “silent killer.” This is especially dangerous for Black patients, who tend to develop hypertension earlier in life and experience more severe complications. Many patients believe they can feel when their blood pressure is elevated, but this is a dangerous misconception that seems particularly prevalent in the Black community.
By the time a Black patient experiences symptoms like headaches or vision changes, it’s often a hypertensive emergency requiring immediate medical attention. We must educate our Black patients that the absence of symptoms does not mean their blood pressure is under control.
It’s a major driver of health disparities
Hypertension is one of the primary reasons for the discrepancy in cardiovascular disease events and deaths among Black Americans compared to other populations. Studies have shown that if we could remove hypertension from the cardiovascular risk factor profile, it would dramatically reduce these disparities.
Black adults in the United States have roughly the highest rates of hypertension in the world. Hypertension is also the leading cause of healthcare disparities between blacks and whites in the U.S. According to the CDC, about 54 percent of Black adults have high blood pressure compared to 46 percent of white adults. More concerningly, Black Americans are more likely to develop hypertension earlier in life and to have more difficulty achieving blood pressure control.
These statistics translate into real-world consequences. Black Americans have significantly higher rates of heart disease, stroke, and kidney disease – all conditions directly linked to uncontrolled hypertension.
Moreover, in my specific field of cardio-oncology, we see that cancer survivors are three to five times more likely to develop hypertension compared to the general population. For those who have received cardiotoxic chemotherapy, hypertension increases their risk of cardiomyopathy and heart failure by two to three times. This underscores the importance of vigilant blood pressure monitoring and management in cancer survivors.
Black patients often face unique challenges in managing hypertension
Many Black patients face systemic barriers that make hypertension management more challenging. These can include:
- Limited access to healthcare: Black Americans are more likely to be uninsured or underinsured, making regular check-ups and medication adherence difficult.
- Food deserts: Many predominantly Black neighborhoods lack access to fresh, healthy foods, making it harder to maintain a heart-healthy diet.
- Chronic stress: The cumulative effects of systemic racism and socioeconomic challenges can contribute to chronic stress, which can elevate blood pressure.
- Mistrust of the healthcare system: Historical abuses and ongoing disparities have led to distrust of medical professionals in some Black communities, potentially affecting medication adherence and follow-up care.
As healthcare providers, we need to be aware of these challenges and work to address them in our treatment plans.
The importance of culturally competent care
To effectively manage hypertension in Black patients, we need to provide culturally competent care. This includes:
- Acknowledging and addressing potential biases within our own care delivery.
- Taking time to build trust with our patients.
- Providing education that is relevant and accessible to our patients’ cultural context.
- Involving family and community in hypertension management strategies when appropriate.
- Being aware of genetic factors that may influence treatment efficacy in Black patients, such as the reduced efficacy of ACE inhibitors as monotherapy (that aid in managing reducing heart failure and diabetes-related kidney complications regardless of race).
Lifestyle changes can make a big impact
While medication is often necessary, we shouldn’t neglect lifestyle modifications. Taking time to counsel patients on diet, exercise, and stress management can lead to meaningful improvements in blood pressure control.
Reducing sodium intake, increasing physical activity, maintaining a healthy weight, limiting alcohol consumption, and managing stress are all evidence-based strategies for lowering blood pressure. As physicians, we should provide specific, actionable advice on these lifestyle changes and help patients set realistic goals.
It’s also important to address any barriers patients may face in implementing these changes. For example, we might need to provide resources for healthy cooking on a budget or suggest safe ways to increase physical activity in patients with mobility issues.
Early intervention is key
Studies show that educating children about healthy habits can influence their families’ behaviors and set them up for better cardiovascular health as adults. We should advocate for hypertension education and prevention starting at young ages, particularly in predominantly Black schools and communities.
One fascinating study from China demonstrated the power of early education. Middle school students who received intensive education on low-sodium diets not only reduced their own sodium intake but also positively influenced their parents’ blood pressure and sodium consumption. This highlights the potential for children to be agents of change in their families and communities.
By instilling healthy habits early, we can potentially prevent or delay the onset of hypertension in future generations of Black Americans.
Technology offers new opportunities
Digital health tools like home BP monitors, smartwatches, and smartphone apps can be particularly beneficial for Black patients who may face barriers to frequent office visits. We should work to ensure our Black patients have access to these technologies and know how to use them effectively.
The importance of physician engagement
As physicians, we play a crucial role in emphasizing the importance of blood pressure control. For our Black patients, this may mean going the extra mile to address concerns, overcome mistrust, and provide comprehensive, culturally competent care.
This may involve longer appointments, more frequent follow-ups, or integrating other healthcare professionals like nutritionists or health coaches into our patients’ care plans. While this approach may require more time and resources initially, it has the potential to significantly improve outcomes and reduce long-term complications in a population that’s been historically underserved.
Final notes
As physicians, we have a responsibility to take hypertension seriously in all our patients, but we must be particularly vigilant with our Black patients who face a disproportionate burden from this condition. By prioritizing culturally competent hypertension management in Black patients, we can make significant strides in reducing health disparities and improving cardiovascular outcomes in this community.
Through a combination of patient education, lifestyle counseling, appropriate medication management, and leveraging new technologies – all delivered with cultural competence and sensitivity – we can improve hypertension control rates in Black patients and ultimately save lives. It’s time to elevate hypertension management to the critical status it deserves in our medical practices and in public health initiatives, with a particular focus on addressing the needs of our Black patients.
Dr. Tochukwu Okwuosa is a Professor and Director of the Cardio-Oncology Program at Rush University Medical Center in Chicago, IL. She earned her medical degree from the Philadelphia College of Osteopathic Medicine and completed her Internal Medicine and Cardiology training at the University of Chicago. Dr. Okwuosa’s primary research interests lie in the areas of Cardio-Oncology and Cardiovascular Disease Prevention. She actively participates in multiple locoregional and national Cardiology/Cardio-Oncology committees and boards, serves as an Associate Editor for the Journal of the American Heart Association, and is the Immediate Past Chair of the American Heart Association’s Cardio-Oncology sub-committee.