Black Adults More Likely to Have Treatment-Resistant Hypertension

(HealthDay News) — Part of the association between race and incident apparent treatment‐resistant hypertension (aTRH) risk is mediated by social determinants of health, according to a study published online May 16 in the Journal of the American Heart Association.

Oluwasegun P. Akinyelure, from the University of Alabama at Birmingham, and colleagues examined the association of multilevel social determinants of health with incident aTRH. The analysis included data from 2,774 White and 2,257 Black U.S. adults taking antihypertensive medication participating in the Reasons for Geographic and Racial Differences in Stroke study.

The researchers found that during a median 9.5 years of follow‐up, 15.9 percent of White and 24.0 percent of Black adults developed aTRH. The excess aTRH risk among Black versus White adults was mediated by low education (14.2 percent), low income (16.0 percent), not seeing a friend or relative in the past month (8.1 percent), not having someone to care for them if ill or disabled (7.6 percent), lack of health insurance (10.6 percent), living in a disadvantaged neighborhood (18.0 percent), and living in states with poor public health infrastructure (6.0 percent).

“These findings suggest that addressing social determinants of health among adults with hypertension may reduce racial disparities in the risk of aTRH,” the authors write.

What is treatment-resistant hypertension?

Treatment-resistant hypertension is a condition where high blood pressure remains uncontrolled even with the use of multiple medications. It’s defined as blood pressure readings that are above goal (usually 130/80 mmHg) despite taking three different classes of medications at their highest tolerated doses, with one of those medications being a diuretic.

There are two main categories of treatment-resistant hypertension:

True resistant hypertension: When medications are truly ineffective in controlling blood pressure.

Pseudoresistant hypertension: When other factors are interfering with proper treatment or blood pressure measurement. These factors can include:

  • Not taking medications as prescribed is a common cause of pseudoresistant hypertension.
  • The white-coat effect, where sme people experience anxiety at the doctor’s office, which can cause their blood pressure to be higher than it normally is.
  • Underlying medical conditions like sleep apnea, kidney disease, and hormonal disorders, can contribute to resistant hypertension.
  • Medication interaction with blood pressure medications, making them less effective.
  • Dietary factors like consuming too much salt or alcohol can raise blood pressure and make it more difficult to control.

How does treatment-resistant hypertension affect Black Americans?

Black Americans are disproportionately affected by treatment-resistant hypertension (aTRH) compared to white Americans. Here’s how it impacts them:

  • Higher Prevalence: Studies show Black adults are more likely to develop aTRH. Research from the National Institutes of Health (NIH) indicates nearly 24 percent of Black adults develop aTRH compared to 15.9 percent of white adults.

  • Social Determinants of Health: Factors that influence health outcomes beyond medical care. A study in the American Heart Association journal Hypertension found that social determinants like low education, income, lack of social support, and living in disadvantaged neighborhoods contribute to a higher risk of aTRH in Black Americans.

  • Potential Underlying Causes: There’s ongoing research into why Black Americans experience higher rates of aTRH. Some possibilities include genetic factors, differences in how the body processes salt, and chronic stress linked to social determinants of health.

  • Increased Health Risks: Like everyone with aTRH, uncontrolled high blood pressure puts Black Americans at a greater risk for stroke, heart disease, heart failure, and kidney problems.

Treatment options for aTRH

Treatment for resistant hypertension may include:

  • Adjusting medications or dosages
  • Addressing underlying medical conditions
  • Making lifestyle changes, such as eating a healthy diet, exercising regularly, and losing weight
  • In some cases, minimally invasive procedures to destroy nerves that are contributing to high blood pressure

Early diagnosis and treatment of resistant hypertension is important to help prevent complications such as heart attack, stroke, and kidney disease.

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