High Blood Pressure and Heart Disease Risk in Black People

This article is part of Health Divide: Heart Disease Risk Factors, a destination in our Health Divide series.

Disparities in housing, employment, and health care have contributed to poor health in racial and ethnic minority communities. This can increase the likelihood of developing hypertension (high blood pressure), which can then increase the risk of heart disease.

Even more, historically marginalized groups like Black people have a harder time accessing high-quality medical care when they need it, underscoring the importance of preventing chronic diseases such as hypertension before they begin. 

high blood pressure and heart disease risk

Zoe Hansen / Verywell

High blood pressure can thicken the arteries, causing undue stress on the heart and blood vessels. Over time, the heart must work harder and harder to overcome this pressure until it eventually gives out.

This article addresses how high blood pressure increases heart disease risk in Black people.

What Is Considered High Blood Pressure?

Blood pressure consistently above 130/80 millimeters of mercury (mmHg) is considered high.

Race and High Blood Pressure

According to a 2018 study in the Journal of the American Heart Association, 75.5% of Black men and 75.7% of Black women who participated in the study went on to develop high blood pressure by the age of 55 years. This is compared to 54.5% of White men and 40% of White women.

High blood pressure is one of the most common causes of heart disease in the Black community.

Still, these numbers are likely an underestimation due to a lack of access to care (and some reluctance to seek care even when it is available), low socioeconomic status, and lower health literacy rates (the degree that people have the capacity to obtain, process, and understand health information).

Why High Blood Pressure Is a Risk Factor for Heart Disease 

High blood pressure levels over a long period of time can thicken your heart muscle and blood vessels, changing the structure and function of these tissues and putting you at risk of heart failure.

High blood pressure not only damages the heart but may also affect other organs of the body—like the kidneys, brain, and liver—putting even more stress on the body and further exacerbating (worsening) your high blood pressure. 

Even at chronically high levels, high blood pressure can show little or no symptoms, which is why it is often referred to as “the silent killer.”

In fact, some people are unaware that they have high blood pressure and only find out after it’s too late. This underlines the importance of:

  • Prevention
  • Early detection
  • Initiating prompt treatment 

Underlying Cause of High Blood Pressure Disparities

The causes of ethnic and racial inequalities that give rise to high blood pressure disparities are complex.

Prevalence of High Blood Pressure in Black People

Black people are 40% more likely to have high blood pressure than White people.

Factors that likely contribute to such a disparity in high blood pressure for Black people include:

  • Substandard insurance coverage
  • Poor access to health care
  • Lower rates of health literacy
  • Socioeconomic status

Additionally, evidence suggests that the longer immigrants of any race live in the United States, the more likely they are to develop high blood pressure. 

One major culprit of high blood pressure that may explain this phenomenon is the adoption of the Southern diet—one that includes a high intake of fried foods, organ meats, processed meats, eggs, egg dishes, added fats, high-fat dairy foods, sugar-sweetened beverages, and bread.

Not only has this been identified as a key reason for the racial gap in high blood pressure, but it also helps to explain the heart disease disparities that are seen among Black people who live in the South compared to other parts of the country.

Of note, gaps exist in the medication compliance (how well a person adheres to taking their prescriptions on time, at the right dose, and at the correct frequency) of antihypertensive therapies (blood pressure medication)—they are highest for non-Hispanic whites and lowest for Hispanics, with Black people falling in between.

The Link Between Stress, Racism, and High Blood Pressure

Racism is a special kind of stress that impacts Black people in a myriad of ways, including raising blood pressure.

Repeated exposure to discrimination and systemic inequity (unfairness within the system) is associated with biological aging of the cells, a phenomenon called biological weathering, which leads to genetic changes that age and lower the functioning of cells. 

Other Risk Factors 

The following lifestyle choices and behaviors increase your risk of being diagnosed with high blood pressure:

  • Eating an unhealthy diet: This is especially true for diets high in sodium, sugar, and saturated fats.
  • Physical inactivity: The COVID-19 pandemic, the globalization of work schedules, and the digital shift that has taken place in almost every industry have contributed greatly to the new norm of living a sedentary lifestyle. The body needs regular physical activity to keep the heart and blood vessels strong and healthy. In fact, regular exercise lowers blood pressure. Without it, you are at a higher risk of hypertension.
  • Obesity: Obesity is associated with high low-density lipoprotein (LDL, the “bad" cholesterol) levels and low high-density lipoprotein (HDL, the "good" cholesterol) levels and atherosclerosis (buildup of fats, cholesterol, and other substances in the walls of the arteries). Together these conditions add stress to the heart and surrounding blood vessels.
  • Excessive alcohol intake: Alcohol may directly contribute to raising one’s blood pressure. Generally, men have more wiggle room than women when it comes to alcohol intake and the development of high blood pressure, but, generally, the less alcohol you drink the better it is for your heart health. 
  • Smoking: The carcinogens (cancer-causing agents) in cigarette smoke damage the heart and blood vessels. Also, nicotine—the addictive component of tobacco cigarettes—has been found to limit the amount of oxygen your blood can carry, forcing your heart to work harder than it ought to.
  • Stress: Stress can temporarily raise blood pressure. Chronic stress can change the body in such a way that the body continues to keep blood pressure high well after the acute stressor is gone.

A normal blood pressure for an adult is less than 120/80 (120 over 80) mmHg. This means that the top number, called the systolic blood pressure, averages less than 120 mmHg, and the bottom number, your diastolic blood pressure, averages less than 80 mmHg.

If your systolic blood pressure is between 120 mmHg and 129 mmHg or your diastolic is higher than 80 mmHg, you are at risk of developing stage 1 or stage 2 hypertension. 

According to the new blood pressure guidelines put forth by the American Heart Association, stage 1 hypertension means that your systolic blood pressure is between 130 and 139 mmHg or your diastolic blood pressure is between 80 and 90 mmHg. Stage 2 hypertension means that your systolic blood pressure is higher than 140 mmHg or your diastolic blood pressure is higher than 90 mmHg.

An Integrative Treatment Approach

High blood pressure is something you can treat.

Below are treatment options for high blood pressure that you could discuss with your healthcare provider.

Medication

The four most common types of hypertension medication are:

These are equally effective in lowering blood pressure, but recent research shows that ARBs and ACE inhibitors may not be as effective in Black people.

Therefore, Black Americans with stage 1 hypertension are generally started on a thiazide diuretic or calcium channel blockers. Why some drugs are more or less effective in some racial and ethnic groups remains a mystery. 

Lifestyle 

Combining medication with diet, exercise, and lifestyle changes is the best way to achieve long-term blood pressure control and keep those levels at a healthy range.

The following lifestyle behaviors not only mitigate acute high blood pressure but may also be preventive in nature if started early:

  • Eat a heart-healthy, balanced diet consisting of fatty fish, leafy green vegetables (like kale, spinach, and romaine lettuce), and low-sugar fruits, limiting salt and saturated fat intake along the way.
  • Maintain a healthy weight. 
  • Exercise regularly: The U.S. Preventive Services Task Force (USPSTF), a volunteer panel of disease-prevention experts, recommends 30 minutes of moderate-intensity exercise (that is exercise that makes you break a sweat, like brisk walking or cycling) five times a week. 
  • Never smoke, and limit alcohol.
  • Get at least seven hours of sleep per night.
  • Limit stress as much as possible. 

All high blood pressure medications have side effects. Be sure to discuss what they are with your healthcare provider before starting on one and always take your medication as prescribed. 

Stress Management 

Chronic stress can damage your heart over time. Like high blood pressure, it is a silent killer in and of itself. Even more, high levels of stress are associated with poor health habits like:

  • Late-night snacking
  • Lack of exercise
  • Sedentary lifestyle
  • Smoking

Limiting stress has immeasurable value in preventing hypertension. 

Taking breaks at work, talking to supportive friends, eating healthy, and going for a run after work or school are some ways that you can manage your stress.

The goal isn’t to avoid stress at all costs—that’s nearly impossible to do—but to find ways to address stressful situations in a healthy way and limit the amount of negative stress that you experience in your life.

Even more, working with a healthcare professional and/or a therapist can help you meet your heart health and blood pressure goals. 

Summary

High blood pressure is a major risk factor for heart disease in Black people.

High blood pressure disparities exist for a wide range of reasons, but differences in socioeconomic status, substandard insurance coverage, and poor access to health care are the primary determinants of disparities associated with poor high blood pressure control.

Still, there is no definitive answer for why high blood pressure is more common and more severe in Black people, but it's likely that genetics and your environment play a role.

A Word From Verywell 

High blood pressure in the Black community is well-documented, and there are several innovative projects that have shown significant and sustained improvements in blood pressure control.

Lessening the racial-wealth gap and funding large-scale research projects that effectively recruit Black people are key to reversing the current trends in high blood pressure, which is serving as a silent killer in the Black community.

Frequently Asked Questions

  • How common is high blood pressure in Black Americans?

    National surveys and large-scale studies have consistently found that Non-Hispanic Blacks (NHB) have significantly higher rates of hypertension compared to non-Hispanic Whites (NHW). Of note, Latinx and non-Latinx Asians (NHA) have lower rates than both groups.

  • What’s the link between race and high blood pressure in America?

    Black people in the United States are more likely to experience systemic racism and institutional inequality that results in substandard insurance coverage and poor access to health care. This can lead to poor high blood pressure control.

  • How does high blood pressure affect the heart?

    High blood pressure gradually remodels the heart and blood vessels and damages other organs, putting excess stress on the heart.

  • How can I find a Black healthcare provider?

    Black healthcare providers are more likely to provide culturally specific care—listening to their patients' concerns and empathizing with their plights. Two places Black people can find Black providers are Blackdoctor.org and FindABlackDoctor.com.

    It must be noted that working with any provider, regardless of race, who can provide culturally competent care is much better than delaying care. Putting off care in search of finding the perfect Black provider is never recommended. 

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