How Blood Pressure Treatment Is Different for African Americans

June 14, 2024

High blood pressure affects African Americans at a higher rate than any other group. Nearly 55 percent of African Americans have high blood pressure – and many respond differently to common medications used to treat other patients.

Gregory Hall, MD, a University Hospitals internal medicine physician with a special interest in health disparities and outcomes in African Americans, says that educated providers and early diagnosis are essential for reducing high blood pressure in the Black community.

Risk Factors for African Americans

High blood pressure affects 75 percent of African Americans over 60, and 30 percent of African American men have high blood pressure at age 30. Black people are also more likely to die from complications related to high blood pressure.

While there aren’t necessarily genetic or biological differences that predispose African Americans to high blood pressure, there are many other important risk factors, says Dr. Hall. These include higher rates of obesity and diabetes, poor diet and smoking. Salt sensitivity rates are much higher in African Americans and that increases high blood pressure, as well as stroke, heart attack and kidney failure risk.

Many in the African Americans have a longstanding distrust in the medical community, which keeps them from seeking care and can make health issues worse, says Dr. Hall. Socioeconomic risk factors include limited access to health care and health education, lower income levels, and other stressors such as unemployment and living in areas with high rates of poverty or crime.

Diagnosing High Blood Pressure

Because there are no real symptoms of high blood pressure, the only way to know you have it is to have your blood pressure checked. This can be done by your primary care provider at your yearly checkup. You can also monitor your blood pressure at home with an at-home blood pressure cuff. These monitors are accurate, fairly inexpensive, and are a good way to stay on top of the whole family’s blood pressure, says Dr. Hall.

Blood pressure consists of two different numbers: Systolic pressure (the top number) measures the pressure inside the artery when the heart contracts. Diastolic pressure (the bottom number) is the pressure when your heart is between beats. Blood pressure falls into these categories:

Normal: Systolic pressure less than 120 and diastolic less than 80
Elevated: Systolic of 120 – 129 and diastolic of 80 or less
Stage 1 high blood pressure: Systolic of 130 – 139 or diastolic of 80 – 89
Stage 2 high blood pressure: Systolic of 140 or higher or diastolic of 90 or higher
Hypertensive crisis: Systolic of 180 or higher or diastolic of 120 or higher

How is Treatment Different for African Americans?

Once diagnosed, high blood pressure can be managed with lifestyle changes and/or medications, depending on the severity.

Dr. Hall says the initial medications that should be used to treat African Americans for hypertension are different from those used to treat other racial and ethnic groups. That’s because these medications work better and have fewer side effects for many Black patients. But because many physicians are not educated on these differences, non-preferred medications are still often prescribed for African Americans.

“That's going to be a huge opportunity to have patients on the right medicine and getting blood pressure back down to where it should be,” says Dr. Hall. “You can decrease the risk of stroke, heart attack and more just by lowering blood pressure.”

Strategies for Preventing Hypertension

There are ways to help prevent high blood pressure from developing in the first place. These include:

Heart-healthy diet: Follow a low-fat, low-salt diet that includes plenty of fruits, vegetables and whole grains.
Keep active: Regular exercise can help prevent high blood pressure. Always talk to your medical provider before starting a new fitness program.
Maintain a healthy weight: Being overweight or obese is a risk factor for high blood pressure. Keeping your weight in check can reduce your risk.
Cut back on alcohol and caffeine: Reducing or eliminating alcohol and caffeine consumption can reduce your overall risk.
Quit smoking: Smoking puts you at risk for high blood pressure in both the short- and long-term. Quitting smoking has multiple other health benefits and reduces your risk of cardiovascular disease, lung disease, cancer and other conditions.

Dr. Hall says it’s important to have a trusted provider who can provide preventive care and disease management, especially if you have a chronic condition like high blood pressure. Seeing your provider regularly can help catch high blood pressure early, when it is easier to manage and before it causes serious complications. They can also monitor how your respond to medications and adjust as needed.

“We want to get your blood pressure to the point where your risk for heart attack and stroke is close to zero,” says Dr. Hall. “This can be accomplished by working with your provider to keep your blood pressure optimally controlled.”