Uncontrolled Blood Pressure Rates in Black Women Reveal Health Disparities

Black women of childbearing age face a twofold risk of uncontrolled high blood pressure compared to their white counterparts, which not only fuels racial health disparities but also heightens the risk of pregnancy-related complications, according to new research published in the Journal of the American Heart Association.

High blood pressure or hypertension during pregnancy is on the rise, occurring in one out of every 12 to 17 pregnancies. When left uncontrolled, the chronic condition can lead to several adverse health outcomes such as preeclampsia, stroke, and preterm birth, the Centers for Disease Control and Prevention (CDC) confirmed.

“Although high blood pressure is a treatable, common chronic health condition, it is a leading cause of pregnancy-related deaths and severe disease,” senior study author Lara C. Kovell, MD, a cardiologist at the University of Massachusetts Chan Medical School in Worcester, Massachusetts, said in a press release. “The United States has much higher rates of pregnancy-related deaths than economically similar countries, and Black women are disproportionately affected.”

The study analyzed hypertension control and social determinants of health (SDOH) in women of childbearing age, focusing on racial and ethnic differences. Researchers aimed to explore the relationship between SDOH, health factors, modifiable health behaviors, and blood pressure control, as well as to identify racial and ethnic disparities in blood pressure awareness and control.

Researchers analyzed National Health and Nutrition Examination Survey data from 2001 to 2018 involving 1,293 women of childbearing age with hypertension. Uncontrolled high blood pressure was defined as a systolic blood pressure of 140 mm Hg or higher and a diastolic blood pressure of 90 mm Hg or higher. The participants also answered questions about their lifestyle, access to healthcare, education, and blood pressure medication use.

The study revealed that Black women with hypertension were more than twice as likely to have an uncontrolled blood pressure than their white counterparts. Furthermore, even among those who were aware of their diagnosis, Black women were three times more likely to have uncontrolled blood pressure. This disparity persisted even after accounting for SDOH, health factors, and modifiable health behaviors.

Researchers also found that the higher rates of uncontrolled blood pressure in Black women were not explained by under-prescription of antihypertensive medications, as more Black women reported having antihypertensive prescriptions than white women. However, barriers to medication adherence, such as cost, complex regimens, and lack of shared decision-making, may fuel these racial disparities.

Meanwhile, the study also found that Asian women were more likely to be unaware of their hypertension and twice as likely to have uncontrolled blood pressure than white women. But, this finding was no longer significant after adjusting for SDOH.

SDOH factors examined in this study included education, income, food security, home ownership, language, health insurance access, and patient care access. SDOH, such as food insecurity, has a large negative impact on hypertension, researchers stated.

“Food insecurity is important when thinking about high blood pressure since sodium levels are higher in many lower-cost food options such as canned, ultra-processed, and fast foods,” Kovell said. “Moreover, food insecurity and a lack of access to healthy foods have been shown in other studies to increase the risk of high blood pressure.”

Black women not only face a higher risk for uncontrolled blood pressure but also experience external SDOH that can exacerbate their health outcomes. The study revealed that food insecurity was more prevalent among Hispanic and Black women, with rates of 32 percent and 25 percent, respectively, compared to 13 percent among white women.

“We were surprised by the high prevalence of food insecurity among Black and Hispanic women. We were not expecting to see such a dramatic inequity in this SDOH,” lead author Claire Meyerovitz, BA, said. “While our population of Asian women was small, we were also surprised to find that 26 percent of Asian women of childbearing age were unaware of their hypertension, which was significantly more than white women at 14 percent.”

According to researchers, further investigation, including analysis of structural racism and discrimination, is required to gain a deeper understanding of the difficulties Black women of childbearing age face regarding food security and heart health.

In addition, the findings suggested that regular screening for food insecurity in medical practices should be a priority, along with guidance on resources such as local food banks or government aid for those in need. At the community level, culturally specific interventions such as partnerships with churches and barber shops have been shown to improve cardiovascular risk factors and blood pressure control.

“Questions about food insecurity and health care access should be included in the standard screening questions at hospital or clinic visits, especially among pregnant women or women planning to become pregnant,” Kovell said. “We still have a lot of work to do to understand and reverse the disparities in maternal mortality between white and Black women in the US.”

Non-clinical personnel like community health workers can play a crucial role in helping patients manage chronic diseases and overcome SDOH-related barriers. By providing language and cultural competence, community health worker programs can benefit underserved populations.

In fact, one study out of the NYU Grossman School of Medicine showed that the additional patient engagement provided by community health workers could lead to improved chronic disease management.

Specifically, the study found that nearly 68 percent of patients in the intervention group achieved optimal blood pressure control, compared to only 42 percent of those in the control group.

The progress made in chronic disease management was largely due to the vital role played by community health workers (CHWs), who possess shared experiences and enjoy community trust that make them uniquely qualified for their positions, Nadia Islam, PhD, associate professor in the Department of Population Health, said. As a result, CHWs are able to provide culturally responsive care, as noted by the researcher.