Hypertension, Race, and Ethnicity: Decreasing the Disparities

Hypertension, or high blood pressure, is a common disease that can damage the heart and cause serious health problems. Blood pressure is affected by the amount of blood one’s heart pumps, and the resistance of blood flow throughout the arteries (more narrow arteries means more resistance to blood flow and higher blood pressure). Hypertension is typically defined as a blood pressure above 140/90 and is considered severe if it is above 180/120.

How do rates of hypertension differ by race?

There are significant differences in blood pressure rates based on race and ethnicity. Research shows that in the United States non-Hispanic Black individuals have significantly higher rates of high blood pressure compared to non-Hispanic white, Hispanic, and non-Hispanic Asian groups. A 2008 study by Annals of Epidemiology determined that non-Hispanic Black individuals had a greater chance of reporting hypertension than non-Hispanic whites, including adjustment for socio-demographic characteristics. There are also significant disparities in controlling blood pressure. Uncontrolled blood pressure is a common issue, but certain groups of people are more likely to have controlled blood pressure than others. Among those recommended to take blood pressure medication, controlled blood pressure is higher among non-Hispanic white adults (32%) than in non-Hispanic Black adults (25%), non Hispanic Asian adults (19%), or Hispanic adults (25%).

Why the disparity?

The reasons for disparities in hypertension and other cardiovascular diseases are complex and layered. Many researchers believe that non-Hispanic Black individuals live fewer years than other American racial and ethnic groups due to hypertension, primarily because of socioeconomic and systemic factors. Individuals with a lower level of education and income have increased risk for hypertension. They are less likely to be aware of the condition, and in turn, less likely to take measures to control the disease. Socioeconomic status (SES) is a strong predictor of hypertension, often due to environmental factors like occupation, health care access, access to healthy foods, and opportunities for physical activity. There are a number of lifestyle factors that increase risk of hypertension, and for which low-SES communities are at disproportionate risk, likely contributing to disparities in hypertension. Examples include: chronic stressors, Adverse Childhood Experiences, physical activity, smoking, alcohol intake, and body mass index. These disparities arise from legacies of systemic racism and discrimination in our communities. Unfortunately, those who live in low socioeconomic areas also experience higher death rates due to hypertension than those in higher socioeconomic areas.

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Why Do Black Americans Have Higher Prevalence of Hypertension?
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Several studies show an association between racism and high blood pressureRacism and stress are closely related, and excess stress can affect the physical and mental health of populations of color who experience racism. Racism can affect mental health through discrimination, structural/institutional mechanisms, and racism in larger culture, and can cause unintentional bias treatment in clinical settings. Unequal treatment in healthcare due to racism is unfair, unjust, and should be forcefully restricted. It is important to increase awareness of racial and ethnic disparities within the healthcare system in the United States among the general public. Diversity, Equity and Inclusion (DEI) courses, programs designed to address unconscious bias, inclusive leadership and anti-racism, are offered virtually or in-person and should be implemented in all health care systems in the United States to decrease implicit bias. The programs are created with evidence based approaches, strategies and techniques which have been proven effective in establishing more inclusive and collaborative workplaces.

Strategies for Decreasing Racial and Ethnic Disparities

Evidence suggests that education leads to more accurate health beliefs in terms of one’s diagnoses, risk, and treatment, and thus better lifestyle choices and greater self advocacy. Educational programs and interventions on hypertension knowledge, self-monitoring and control are necessary for patients. Studies also show that a low education level can directly lead to increased incidence of hypertension, so increasing quality education opportunities and improving the vital condition of lifelong learning overall is a potential strategy for decreasing hypertension disparities.  

Individuals that live in low income neighborhoods experience poorer health outcomes due to a combination of related factors, including lack of adequate housing conditions, food access, and employment opportunities. Low socioeconomic citizens are more likely to suffer from hypertension and less likely to have access to credible resources on prevention methods. It is important that communities and community leaders actively account for harms to health associated with low socioeconomic status. There are multiple strategies that can help low and moderate income families build wealth. Policies that enable families to save early like children's savings accounts, automatic saving accounts, building equity in a home and removing barriers to building assets and help families build emergency savings are key. More families can be on the pathway to building stronger balance sheets through reform of saving incentives in the tax code and long-term saving efforts. 

Living conditions and neighborhood or community can largely affect overall health. We know that where someone lives and works affects how much we exercise and what food we eat. Low income areas are less likely to have access to healthy food options and more likely to have less healthy food options, like fast food restaurants, making it cheaper and more convenient to eat unhealthy food than to consume healthy options. Food insecurity affects the food intake and eating habits of those who live in food insecure areas. Locally-run farmers markets that accept food assistance, food distribution programs, and gardening are great tools for communities to increase healthy food access. Food assistance programs like the National School Lunch Program and the Supplemental Nutrition Assistance Program address barriers to accessing healthy food. More programs like these will decrease food insecurity in low income neighborhoods, potentially decreasing hypertension in low income neighborhoods.

Physical activity is one of the main protective factors against high blood pressure. Taking the stairs, going for a walk, and adding movement to house work are all easy ways to integrate physical activity into daily life. Those living in low socioeconomic areas typically have lower quality activity environments, sometimes due to increased crime rates, which makes it more difficult to move as much. Environments can be designed to increase opportunities for physical activity, and to be more accessible in general, via adding active transportation through safe, connected walking and cycling infrastructure. Adding higher quality activity environments can decrease levels of hypertension everywhere, especially in low-income neighborhoods. 

There is a need for successful, cost-efficient interventions at the state and national level when it comes to reducing the health disparities. Culturally appropriate interventions will minimize the morbidity and mortality rates for these areas. Before policy changes can be made, enhancing our understanding of the association between race and physical and mental health is essential. Before we can even educate ourselves, advancement in research efforts within ethnic data collection is necessary.

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