High Blood Pressure (Hypertension) Enemy #1 in the African American Community

Hypertension in the African American Community

If you are like most people, you or someone you know has high blood pressure. For a variety of reasons, the unfortunate truth is that the prevalence of hypertension in African Americans is among the highest in the world. This fact makes hypertension one of our primary targets in the campaign to improve health and wellness.

Poorly controlled hypertension can lead to a variety of serious health problems including strokes, heart disease and kidney failure. African Americans suffer from the complications of hypertension at alarmingly high rates. Often, we do not receive treatment until the blood pressure has been elevated for many years and has already began to damage organs in the body.

Compared to Whites, African Americans develop hypertension at an earlier age and are more prone to have substantially elevated pressures. Data reveal that compared to the general population, African Americans have:

• A 80% higher death rate associated with strokes due to hypertension.
• A 50% higher death rate associated with heart disease due to hypertension.
• A 320% higher death rate associated with end-stage kidney disease.

Quick Refresher: The Basics of Our Circulatory System

Our circulatory system consists of several components that act in harmony to transport nutrients and oxygen to our tissues and remove waste products. Let’s quickly review the key components.

Blood	A fluid made up of blood cells and plasma that circulates throughout the body. Blood caries a variety of substances (oxygen and waste products) that are transported between various organs and tissues.
Heart	Muscular organ that pumps oxygen poor (deoxygenated) blood into the lungs and pumps the newly oxygenated blood out to the body.
Vessels	Vessels are arteries and veins and can be thought of as the “tubing” which carries blood throughout our bodies. For the most part, arteries are the blood vessels that carry oxygen rich blood to our organs and tissues. Veins carry the oxygen poor blood back to the heart.
Lungs	Responsible for the oxygenation of our blood.

What is Blood Pressure?

Blood pressure refers to the pressure blood exerts against the walls of the main arteries in our bodies. The systolic pressure is the pressure in the vessels when the heart is pumping. The diastolic pressure is the pressure of the blood between heartbeats (when the heart is at rest). When you see or are told of a blood pressure of 120/80 or 120 over 80…the systolic pressure is120 and the diastolic pressure is 80.

What Defines Hypertension?

Hypertension is defined as an average systolic blood pressure of 140 mm Hg (millimeters of mercury) or higher and/or an average diastolic blood pressure of 90 mm Hg or higher. It is important to point out that blood pressure readings can be different at varying times of the day and can be elevated with stress or anxiety. Therefore, the determination of a person being labeled as “hypertensive” is usually based on the average of three blood pressure readings taken on different days. The following chart is adapted form the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI).

Category	Systolic (mm Hg)		Diastolic (mm Hg)
Optimal	<120	And	<80
Normal	<130	And	<85
High Normal	130-139	Or	85-89
Hypertension Stage 1	140-159	Or	90-99
Hypertension Stage 2	160-179	Or	100-109
Hypertension Stage 3	>=180	Or	>=110

Hypertension and Diabetes Mellitus

Controlling blood pressure is extremely important in diabetic patients with hypertension. Properly controlling blood pressure helps to prevent damage to the kidneys and can help to control the development of diabetic nephropathy (diabetes related kidney disease).

The goal for diabetic patients with hypertension is to keep the blood pressure below 130/85 mm Hg. A combination of anti-hypertensive medications and lifestyle changes (especially weight loss) should be used to reach this blood pressure goal.

Hypertension Associated with Birth Control Pills

Many women taking birth control pills experience a small increase in blood pressure, but the pressure usually remains in the normal range. Hypertension has been reported to be 2-3 times more common in women taking birth control pills and is most evident in obese and older women. Women over 35 years of age who smoke are advised against taking birth control pills as they are at an increased risk of developing hypertension.

Hypertension and Kidney Disease

The early detection of kidney damage from hypertension is very important. Your doctor can order blood tests that can determine whether or not there is evidence of damage. Blood pressure should be controlled to levels of 130/85 mm Hg or lower. The goal here is to prevent advanced or “end-stage” kidney failure requiring the need for dialysis.

Evaluation and Diagnosis

The initial screening for hypertension is fairly simple and straightforward. All you need to do is have your blood pressure measured with a cuff that is placed around your arm and then inflated (technically it is called a sphygmomanometer). As a basic rule, if the average of three blood pressure readings (on different days) is over 140/90 mm Hg it can be concluded that you have hypertension.

The exact cause of hypertension in most cases is not known. In the medical community this is referred to as “essential” hypertension. A combination of genetics, diet, and lifestyle certainly play a large role in the development of high blood pressure. It is very important to point out that if you develop hypertension at a young age or the hypertension develops suddenly, your doctor should carefully evaluate you for causes of hypertension that are potentially reversible. You may need special studies that will evaluate the vessels that supply blood to your kidneys and for other potential disorders in your endocrine system.

Treatment

Lifestyle Changes

For most individuals, the first step in treating hypertension is to make lifestyle changes. This means losing weight, increasing the amount of exercise you get, and changing your diet. Our accompanying article Controlling Hypertension Throughout Our Life Cycle discusses these lifestyle changes in more detail. In general, decreasing the sodium (salt) in your diet, eating more fruits and vegetables, and getting more aerobic exercise can help to lower your blood pressure. It will take some effort on your part!

Anti-Hypertensive Medications

If the lifestyle changes mentioned above are unable to control your blood pressure, your doctor may prescribe medication(s). There are a variety of different medications available and your doctor will prescribe the medication that is best for you. Some medications are better for people with diabetes, heart disease, kidney disease, etc. If you cannot tolerate a certain medication because of adverse side effects, there are other options.

Many people are often opposed to “taking a pill every day.” Please, please, please remember that taking a pill every day can be a much better option than developing a stroke, heart attack, or needing to have kidney dialysis because your blood pressure ran out of control for too long.

Empowerment Points

• Hypertension (high blood pressure) is often asymptomatic but over time it leads to a variety of health problems including heart disease, strokes, and kidney failure.
• The prevalence of hypertension in African Americans is among the highest in the world.
• Have your blood pressure checked and if it is elevated discuss treatment options with your doctor.
• The only way that we can beat hypertension is to confront it head on—make lifestyle changes and take your medication if your doctor prescribes it!