Table of Contents
Untreated high blood pressure leads to disability and death.
Usually a silent disease, high blood pressure, also known as hypertension, puts unusual stress on blood vessels, typically more stress on the arteries that carry blood away from the heart than the veins that carry it back. At strictures and bends, blood vessels are injured, attracting white blood cells. These white blood cells in turn feed on cholesterol that gets "stuck" in the walls of the blood vessel and become lodged in the lining themselves, where they attract still more blood cells that accumulate, die, and calcify. These arterial blockages make hypertension even worse, and set the stage for heart attack, congestive heart failure, kidney failure, and stroke.
By the age of 60, over half of all people of all races all over the world have a condition called "essential" hypertension, which is high blood pressure that is not associated with any clear causative event. People of African descent in the United States, however, have a 50 percent higher risk of hypertension than people in other racial groups. They have an 80 percent greater risk of fatal stroke. They have a 90 percent higher risk of heart disease, and a 320 percent higher risk of end-stage kidney disease. Taking care of blood pressure is extremely important for African-Americans, and probably for people of sub-Saharan African heritage all over the world.
Why Do African-Americans Have Higher Rates of Hypertension?
Researchers believe that the reason African-Americans have higher rates of high blood pressure as well as higher rates of the diseases it causes is genetic. Data from the Hypertension Genetic Epidemiology Network suggests that it isn't just a single "Black gene" that is linked to the problem. There are multiple genes that cause hypertension that happen to be more common in African-Americans, and at least two of them are activated by smoking. African-Americans who smoke are at even higher risk for high blood pressure that causes heart disease, plus there are still more genes that increase susceptibility to kidney failure if blood pressure is not controlled.
Do the Approaches to Blood Pressure Management That Work for Other Groups Work for African-Americans?
It's generally accepted that everyone needs to keep their blood pressure levels down to 140/90 (systolic pressure between 110 and 140 and diastolic pressure no higher than 90), but problems arise when doctors try to give all their patients the same medications. Here are some problems in blood pressure management that come up over and over again for African-Americans:
- Thiazide diuretics (commonly known as "pee pills") are extremely inexpensive and modestly effective, but they are usually more dangerous for people of African-American heritage because they elevate the risk of developing diabetes. Fortunately, fewer and fewer doctors prescribe diuretics for blood pressure management.
- Isosorbide mononitrate and similar drugs (marketed as Imso and Imdur) lower blood pressure by helping arteries relax. However, in African-Americans they tend to help the arteries relax too much, causing congestive heart failure.
- ACE-inhibitors (medications that have generic names that usually end in -il, such as lisinopril, ramipril, and so on) and ACE-receptor blockers (such as losartan) are helpful in preventing kidney disease, especially for people who have both high blood pressure and diabetes. Unfortunately, many doctors don't routinely prescribe them to African-American patients.