New Blood Pressure Guidelines Point To Dangers for African-Americans

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.

READ Signs and Symptoms of High Blood Pressure

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.

Does Diet Make A Difference In Managing High Blood Pressure For African-Americans

Many people of all races resist the idea of modifying their diets to control a disease like high blood pressure that has few obvious symptoms. African-Americans are no exception to this rule. A study conducted by two scientists at the University of North Carolina at Charlotte found that among African-Americans told they have high blood pressure:

• 75 percent were willing and able to give up or greatly reduce drinking alcohol.

• 67 percent were willing and able to give up smoking (in North Carolina, this is a huge commitment).

• 33 percent were willing and able to change their diets, and

• 22 percent were willing and able to reduce their consumption of salt.

There's more resistance to changing eating habits that there is to any other aspect of high blood pressure control. The relatively few African-Americans in this study who were willing to make dietary changes tend to be women who lived alone and had a care coordinator with their health insurance plans. Men and people who don't have insurance tended to be less likely to change the way they eat. And the reality is, if you have a lot of hardships in your life, you usually don't want to give up food, too. Changes in diet have to be subtle. Here's one way to do it.

Eat as you normally eat, but:

• Eat fresh foods rather than canned foods. It's better to eat greens you grow in the yard than greens you get in a can.
• Cook foods that are naturally tasty. It's better to rely on the taste in the food than the taste you put on the food.
• Don't leave out salt entirely, but use many other herbs and spices to add flavor.
• Don't leave out grease entirely, but don't let your food float in it. And, most importantly
• Eat good food often, so you don't feel a need to stuff yourself when you eat well.

Does this approach really work?

There's good evidence that it does. In 2003, the British National Health Service realized that persuading Britons to consume less salt could save lives, prevent disease, and save the health system a tremendous amount of money. The National Health Service, however, didn't just lecture people on how they needed to eat differently. They worked with bakeries and canneries and restaurants to encourage them to develop food that tasted good with less salt.

READ Living With High Blood Pressure

Their plan worked. By 2011, average daily consumption of salt per person in the UK was down to 9.5 grams, which is still a lot of salt. However, this was a 15 percent reduction in sodium from eight years earlier. There was a 40 percent drop in heart disease and a 42 percent drop in fatal strokes. All of this came from simply cooking food that tastes good despite containing less salt. African-Americans may not achieve total health by tweaking family recipes, but it's not necessary to give up on flavor to promote health.