High blood pressure may be deadlier for Blacks. Blacks with hypertension are twice as likely as their white counterparts to suffer sudden cardiac death, according to a recently released study.
The study appeared in HeartRhythm and was authored Dr. Peter Okin, a professor of medicine at Weill Cornell Medical College and an attending physician at New York-Presbyterian Hospital/Weill Cornell Medical Center. It found that there seemed to be no specific reason for the increased risk, though the researchers suggested possible genetic, structural or functional differences.
“One of the biggest reasons why this is not surprising is that the socio-economic profile of African Americans has not changed significantly in America for decades,” says Dr. David Martins at Charles R. Drew University of Medicine and Science. “African Americans still comprise the majority of the poor, uninsured and underserved in America with significant predisposition to stress-related illnesses like high blood pressure and its associated devastating outcomes. The same factors that predispose this vulnerable population to the occurrence of illnesses impair the ability of the people to seek and receive health care. When day-to-day living is a struggle, then healthy living  becomes secondary.”
There was one aspect of the study that was surprising, says Dr. Tracy Muhammed, a doctor for Chicago-based Access Community Health Network (ACCESS), one of the largest networks of federally-qualified health centers in the country. ACCESS operates nearly 50 community health centers located in underserved, low-income neighborhoods throughout the Chicago area. “One thing that is surprising after they adjusted the study for factors like age, diabetes and BMI (body mass index, a number calculated from a person's weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems) is that you still see Blacks that are twice as likely to die from sudden cardiac death (SCD). We usually associate SCD with high blood pressure, diabetes, high cholesterol and obesity. They adjusted data so that these things didn't exist, so I wonder why Blacks are still twice as likely to be subject to SCD,” notes Muhammed. “There may, however, be a genetic component present. While in medical school in the mid-'90s, we discussed the evolution of the renal system and blood pressure and how breeding and the slave trade might be factors related to high blood pressure.”
There is a school of thought that points to the transatlantic slave voyage as the root of the problem. According to this theory, African Americans who survived the slave trade's Middle Passage were only those who could hold more salt in their body. This would mean that the high hypertension rate among African Americans today is an evolutionary by-product of the slave trade. Los Angeles-based podiatric surgeon Dr. Bill Releford, founder of the Diabetic Amputation Prevention Foundation, as do many other physicians, discounts this theory. “A 90-day voyage is not enough to change the genetic make-up of a race,” he points out.
Releford does believe in one possible slave connection. “The diet of Southern slaves ... passed down through the generations contributes to diabetes," he said. He adds, “When you look at West Africa, you do not see many instances of high blood pressure. We (African Americans) are not eating the foods our ancestors ate. We are not getting enough sun. In the cities where it is cold, like Chicago, Black men suffer more from high blood pressure than those in warmer climates. Also, our lifestyle has changed drastically, but our bodies still need the same as our ancestors.” Releford also points to a variety of other factors that exacerbate hypertension—“racism, social economic disparity, lack of education and eating a lot of high-processed food.”
Nathan S. Bryan, Ph.D. Professor of Molecular Medicine, The University of Texas Health Science Center at Houston, suggests something else. “The truth is, it is not surprising. It is well established that African Americans have higher incidences of cardiovascular disease including hypertension. The real story should be why,” he says. “There is substantial evidence that African Americans produce less nitric oxide which would explain the health disparities.”
The fact remains that Blacks do suffer in great numbers from hypertension, but this condition can be prevented. But, says Dr. Martin, the effort should not only be individual but government wise as well. “The most important thing that can be done to prevent high blood pressure is a community call to action. The community needs to be supported to reduce its own stress level. The city, state and local government agencies need to ensure that the communities are adequately resourced for healthy living,” he explains. “People do not exercise outdoors when they feel unsafe and most cannot afford indoor exercise equipment. Single mothers having to work 2 and 3 jobs to feed the children and keep a roof over their heads. There is no time for exercise or healthy cooking at home. The social support services are currently inadequate and misdirected.”
But steps need to be taken on an individual basis as well. “Diet and exercise are important, but it is more intense. People must understand diet and low sodium intake; we need to watch the seasonings that we use while cooking meals,” advises Muhammed. “We should also watch preservatives that often contain sodium, which can increase our blood pressure. Some Blacks are more prone to drinking soda and other drinks, instead of water. Dehydration can have an effect on the kidneys, which can lead to increased blood pressure. If we become dehydrated, our body retains sodium, and this can have a bad effect on the kidneys. Normal levels are considered 126 over 80; anything above is considered elevated. Doctors try to treat and control blood pressure before it causes organ damage.”
Dr. Bryan adds there there may be another important factor. “African Americans  in particular should become aware of their nitric oxide (NO) levels/status as early in life as possible to take necessary steps to restore NO production and prevent a state of chronic NO insufficiency,” he says. “Moderate exercise and eating a diet rich in NO activity (kale, spinach, beets, etc) can promote NO production in the body and prevent many of these conditions associated with low NO.”
And as Dr. Releford pointed out, the lack of sun, which stimulates vitamin D may be key. “It is fairly well known in nutritional circles that African Americans are far more predisposed to hypertension, cardiovascular diseases and several cancers. How is this possible? The underlying issue is vitamin D deficiency,” says Dr. Lucinda Messer, ND, a licensed naturopathic physician, vitamin D researcher and author of Powerful Medicine: Vitamin D, Shedding Light On a Worldwide Health Crisis. “The darker your skin, the higher your melanin content. Therefore, the higher your requirement for sun exposure intake of this nutrient. White (pale skin) requires 20-30 minutes of midday sun to absorb an optimal dose of vitamin D; whereas, if you have Latin/olive skin it might take 1-1/2 hour; if you have dark skin, it may take upwards of three full hours in the midday sun in order to absorb enough vitamin D for health. If you have dark pigmented skin, your physiological requirement is higher than that of a white person. Your body has the genetics that require higher levels of vitamin D in order to transform it into a very powerful secosteroid hormone in your body, Calcitriol is the activated form of vitamin D.”
Of course, regular doctor visits and education are also key. And on that note, in 2007, Releford began the Black Barbershop Health Outreach Program to raise awareness of the diseases that plague the Black community. Participating barbershops offer free blood pressure readings and glucose screenings as part of the national outreach program. To date, the program has screened more than 30,000 men in 38 cities with a goal to reach 500,000 by 2014. At the barbershop, men can get screened for diabetes and hypertension; educated about symptoms and prevention (diet, exercise and a healthy lifestyle); and referred to local providers who offer free or low-cost health care. “We found that Black men don't go to the doctor, so barbershops seemed like the ideal place to do this program. And we have been very successful.”
If you suffer from hypertension, there are lifestyle choices you need to make. “Set your priorities right. Life and health are more important than brand name clothes, big cars and homes. Live within your means. Monitor and manage your weight. It is a lot easier to lose 5 lbs today than wait till next month to start struggling to lose 10 lbs. Watch what you eat because you are what you eat. Play games and sports with your friends and family on a regular basis. It is more fun than exercise. Find a doctor that puts you in the driver's seat and guides you from where you are to where you need to be in health. Take your medications as directed,” suggests Martins. “Your health is your business. Be involved. It is not your burden to try to understand. It is the duty of the doctor to make you understand. Do not be ashamed to ask questions.”