Hypertension is a silent killer that afflicts over 77 million people in USA. The prevalence of this disease is higher among African-Americans than other ethnic groups. Especially, more than half of the population of African-American women suffers from hypertension and the associated disorders. Apart from genetic factors, a slew of environmental factors including obesity and lack of activity, diabetes, poor diet, alcohol consumption and stress are contributive to this growing phenomenon among black women. This paper has discussed this issue in more detail along with the recommended interventions necessary to keep this condition under check.
Hypertension is a debilitating disease that afflicts 26% people in the world. Regarded as the silent killer, hypertension does not show any external symptoms, but gradually hardens arteries leading to higher risks for kidney failure, cardiovascular diseases and stroke (Kearney et. al, 2005). In USA, over 77 million people are recorded to be suffering from hypertension currently, and the number is expected to increase within the next 15 years as a significant chunk of the US population grows old (AHA, 2013). Though hypertension, also known as high blood pressure, is quite common among American people, it is more prevalent among African Americans than other ethnic communities. According to the American Heart Association, the prevalence of high blood pressure among African Americans is the highest among any ethnic group in the US (St. John Providence Health System, 2014). A new research study in Circulation: Cardiovascular Quality and Outcomes shows that high blood pressure is more prevalent among African women than African men, white men and women. A study conducted on 70,000 people in the 12 southeastern states within USA, known as the 'Stroke Belt' because of higher rate of stroke incidents, showed that 64% African American women suffer from hypertension compared to 52% white women and 51% black and white men (AHA, 2013). This essay would discuss the causes of high prevalence of hypertension cases among African-American women and the interventions to reduce this phenomenon.
What is Hypertension?
Hypertension is a medical terminology of the condition called high blood pressure. When blood is pumped into the system by the heart, it puts pressure on the artery walls. When the pressure exerted by the flow of blood becomes heavier on the artery walls, it results in a condition known as high blood pressure or hypertension. Systolic refers to the pumping phase of the heartbeat, and diastolic refers to the resting phase between heartbeats. Blood pressure number is read with the systolic number over the diastolic number (St. John Providence Health System, 2014). According to the National Heart, Lung, and Blood Institute (NHLBI), in a normal healthy person, the blood pressure at a systolic level should be less than 140 and less than 90 at a diastolic level. When the blood pressure becomes at least 140 or higher at the systolic level and at least 90 or higher at the diastolic level, it is considered as hypertension or high blood pressure (St. John Providence Health System, 2014). However, hypertension is diagnosed when several readings of blood pressure on different occasions show high blood pressure level.
Causes of Hypertension among African American Women
There are various opinions as regards the causes of the prevalence of hypertension in African American women. According to some researchers, genetic factors account for the higher rate of prevalence of hypertension in Black American women, while another group of researchers believe that environmental factors are more to be blamed for the condition.
According to some researchers, African Americans have an enhanced ability to store sodium in their blood, a phenomenon that might have resulted from their days of slavery when they were transported from Africa to USA via ships. This ability to store sodium in blood protected the black African slaves from fatal salt-depletive diseases like diarrhea and vomiting, but the same ability now contributes to hypertension when their descendants consume American foods, which are higher in sodium content compared to African foods (Fuchs, 2011). A team of researchers from the National Institutes of Health (NIH) conducted a study on 1,017 African Americans in 2009 and made the discovery of five genetic variants that explain the high prevalence of blood pressure in Black Americans. In order to probe further into their findings, the researchers examined DNA of 980 West Africans with or without high blood pressure, and they discovered that the genetic variants detected in African Americans matched with the blood pressure of West Africans (NIH, 2009). This finding is of great significance because many African-Americans are the descendants of the Western Africans.
Besides genetic factors, environmental factors such as lifestyle, obesity and physical inactivity are also responsible for the growing number of hypertension cases among African Africans. A few environmental factors are discussed below:
Obesity and Lack of Exercise
Obesity is a condition that has affected USA in epidemic proportions, but if any race that has been hit the hardest by this epidemic is African Americans, especially, the black women. In comparison with 32% white women and 41% Hispanic women, 60% black women are obese (Dingfelder, 2013). According to the National Institutes of Health (NIH) and Centers for Disease Control (CDC), obesity or overweight is one of the primary reasons for high blood pressure. In order to check obesity, one needs to follow a regular exercise regimen along with controlling diet, but many African American women avoid exercising in order to protect their expensive hairdo (Dingfelder, 2013). Since hairstyle maintenance and hair care are quite expensive, many African Americans prefer to lead a sedentary lifestyle and forgo any sort of activity that can ruin their hair.
Poor diet also contributes to hypertension and cardiovascular diseases. An unhealthy diet, constituted of high calorie and high fat foods, results in clogging of the arteries and veins by fatty deposits. Such diet initially raises blood pressure in our body and if not controlled, gradually will affect heart and other vital organs of the body. African American women, due to the lack of knowledge and proper education and also due to the poor socioeconomic conditions, nurture very poor dietary habits. Compared to women of other ethnic groups, African American women consume the highest quantity of high fat, high calorie and high cholesterol food per day. Their average diet includes 43% of total calories from high fat foods with over 15% from saturated fat (Huggins, 2006). As a result of such poor dietary decisions, African American women suffer from higher rate of obesity and hypertension.
Alcohol consumption is another contributive factor to hypertension. Heavy drinkers who consume at least two drinks per day are two times more likely to develop hypertension than non-drinkers. It has been observed that alcohol consumption among African Americans, especially women, is considerably lower than white women. However, it is seen that African American women start drinking heavily in the middle age, and this habit leads many black women to develop hypertension in their middle years (NCADD, 2014).
Stress is another contributive factor for hypertension. Stress shoots up adrenaline in our body leading to an increase in blood pressure. African American women are more stressed out than white women. Studies show that black women frequently encounter racial discrimination and unfair treatment in employment and housing that add to their stress level (Scott, 2013). Furthermore, material hardship and other stressful life events such as job loss, divorce and marriage also take a toll on their health. As a result, black women not only begin to suffer from hypertension earlier than their white counterparts, they also suffer from accelerated aging, diabetes, obesity and cardiovascular diseases.
Interventions involve techniques and methods that help keep the risk of hypertension at bay. It also helps the patients of high blood pressure keep their pressure under control. There are many well-tested and proven interventions, which if followed, can whittle away the risk of hypertension significantly. Below are discussed some of the intervention techniques that could prove helpful for African American women to keep their high blood pressure under control.
Reduction in Dietary Sodium (Salt) Intervention
Salt is considered as one of the biggest culprits of hypertension. Salt regulates the fluids in our body. A normal healthy person needs only 500 mg of sodium daily (UMMC, 2013). However, the American fast food culture is high on sodium content, and therefore, African American women, who nurture poor dietary habits, often consume food that are not only high in calorie but also high in salt content. Furthermore, due to genetic reasons, African Americans have an enhanced ability to store sodium in their body. Hence, any high sodium diet may only increase their risks of hypertension. Therefore, black women should significantly cut down on their sodium intake by reducing the fast food consumption and canned foods. Research has shown that even a small percentage of reduction of salt intake can improve the systolic pressure. For example, Cutler and his team have observed that if the salt intake can be reduced by 77mmol/day, then the systolic pressure will reduce by 1.9mmHg (NHLBI, 2014).
Weight Loss Intervention
After the diagnosis of hypertension is made, one may either opt for prescribed medication or go for lifestyle changes to keep hypertension at bay. According to CDC and NIH, obesity or overweight is one of the primary causes of hypertension. Therefore, the loss of even a small amount of weight may bring the blood pressure down and control high blood pressure. However, a person of normal weight or an underweight person may also suffer from hypertension if he is not careful about diet and lives a sedentary life style. It is imperative to cherish healthy life style practices composed of healthy and balanced diet and a routine exercise program. The clinical review “Clinical Guidelines for the identification Evaluation and treatment of overweight and obesity” also emphasizes upon weight loss to reduce blood pressure (NHLBI, 2014). The findings of 11 research studies show that a significant weight loss contributes to the reduction of both systolic and diastolic pressure. 2 pound reduction of body weight reduces systolic blood pressure by 1.6mmHg and diastolic blood pressure by 1.3mmHg (NHLBI, 2014). In fact, weight loss not only helps in the reduction of blood pressure immediately, it also keeps the pressure from increasing further. Weight loss is very useful for reducing blood pressure in overweight people suffering from hypertension.
Education and Awareness
Lack of education among African-American communities is one of the main reasons for the widespread and increasing rate of hypertension cases among African-American women. Only 18% African-American fourth graders in the U.S born families and 7% of the immigrant families scored higher than “proficient” in reading in a survey conducted by Annie E. Casey foundation (Bossip, 2014). It has also been found that African-American women are far more likely to conceive their first child during teenage years than their Asian or white counterparts. This shows that the overall education and awareness of African-American females are quite inferior to the country’s average. They are in many cases ignorant about the causes and after-effects of hypertension. Community awareness programs on hypertension will help them learn about how obesity, poor dietary decisions, alcohol consumption and lack of exercise can lead to high blood pressure. Schools, media, government agencies and NGOs should take a combined responsibility to make the African-American community aware of the evils of hypertension and how it can be detrimental for the health and well-being of women.
Hypertension is one of the most prevalent diseases in USA. The number of hypertension cases is slated to increase significantly over the next few years as a large portion of the US population grows old. Among all the ethnic groups in USA, hypertension is highest among African-American women. There are several reasons contributing to hypertension among black women. Genetically, the body of an African-American person can retain more sodium than a normal white American person. The higher sodium content in the body leads to higher chances of developing hypertension. There are other factors like high obesity rate among African-American women, high sodium and high fat diet, diabetes, stress and overconsumption of alcohol leading to hypertension among African-American women. Interventions like low sodium diets, weight loss programs and better quality of education and awareness will help reduce the number of cases among African-American women significantly.
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