Hypertension on a Global Scale and How it Impacts the Black CommunityMay 13, 2022 11:00AM ● By Candice Stewart
Hypertension, also referred to as elevated blood pressure, is a severe non-communicable disease (NCD) that significantly increases the risk of heart, brain, kidney, and other diseases. It is also one of the top causes of death and disease throughout the world.
Hypertension Risk Factors
Some of the risk factors for hypertension are generally classified as modifiable and non-modifiable. The non-modifiable risk factors include a familial history of hypertension, having co-existing diseases such as diabetes and kidney disease, and generally being over the age of 65. The modifiable risk factors, those that can be addressed to reduce the chances of hypertension, include physical inactivity, unhealthy diets, overconsumption of alcohol, and smoking.
The unhealthy diets mentioned include those that are high in saturated fats, trans fats, and sodium. Not to rub salt in wounds, but the “additional flavor” you add to your meals with various seasoning shakers to add the right taste often includes salt. This leads to excessive salt intake over a period of time. Something you might not know is that sodium is sometimes hidden in other foods you consume. So over time, this also adds to the excessive consumption of salt in your diet.
According to the WHO, reducing salt intake to less than 5g a day is a recommended way to reduce the burden of hypertension. | Photo source: pexels.com
Additionally, the lack of physical activity plays a crucial role. Exercise is beneficial to the body externally and internally. To make matters slightly worse, the COVID-19 pandemic forced many to work remotely which led to a decrease in activity.
The report is quoted as stating,
“The global outbreak of COVID-19 has resulted in the closure of gyms, stadiums, pools, dance and fitness studios, physiotherapy centers, parks, and playgrounds. Many individuals are therefore not able to actively participate in their regular individual or group sporting or physical activities outside of their homes. Under such conditions, many tend to be less physically active, have longer screen time, irregular sleep patterns as well as worse diets, resulting in weight gain and loss of physical fitness. Low-income families are especially vulnerable to negative effects of stay-at-home rules as they tend to have sub-standard accommodations and more confined spaces, making it difficult to engage in physical exercise.”
Though a decrease in activity can lead to many issues, it should not be ruled out as a factor in the development of hypertension.
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Known as a silent killer and a lifestyle disease, the rates of hypertension on the global scale are high enough to raise your blood pressure. It is known as the silent killer as many will not know about their relationship with the NCD until it’s too late. It is a lifestyle disease as the modifiable risk factors can be easily addressed before the disease manifests or before it gets worse.
A Global Look at the Occurrence of Hypertension
A 2021 report prepared by the World Health Organization and Imperial College London from a study executed, revealed that there are more than 700 million people with untreated hypertension. They state that the number of people living with hypertension has doubled to 1.28 billion since 1990.
The study, which is the first comprehensive global analysis of trends in hypertension prevalence, detection, treatment, and control, led by Imperial College London and WHO stated that “the number of adults aged 30–79 years with hypertension has increased from 650 million to 1.28 billion in the last thirty years.” Additionally and sadly, “Nearly half these people did not know they had hypertension.”
The irony in this revelation is that hypertension is easily detectable by measuring blood pressure, at home or in a healthcare facility. It is also often effectively treated with medications.
The study covered the period 1990–2019 and used blood pressure measurement and treatment data from over 100 million people aged 30–79 years in 184 countries, which account for 99% of the global population. This makes it the most comprehensive review of global trends in hypertension to date.
The research found that though there was little change in the overall rate of hypertension in the world from 1990 to 2019, the burden shifted from wealthy nations to low and middle-income countries. The rate of hypertension has decreased in wealthy countries – which now typically have some of the lowest rates but have increased in many low or middle-income countries.
This is seen where countries like Canada, Peru, and Switzerland were among those with the lowest prevalence of hypertension in the world in 2019 while some of the highest rates were seen in countries such as the Dominican Republic, Jamaica, and Paraguay among others.
So what is seen is that men and women in sub-Saharan Africa, the Caribbean, central, south and south-east Asia, and Pacific Island nations are the least likely to be receiving medication. Treatment rates were below 25% for women, and 20% for men, in a number of countries in these regions, creating a massive global inequity in treatment.
Here are some graphical representations from the study indicating the countries worst impacted by hypertension. To view tables showing countries with improved states of hypertension, visit here.
Tables source: World Health Organization
Among the countries with high incidences of hypertension are those from the African diaspora. These include Afro-Caribbean countries, African nations, and a few other countries with populations of Black people.
In true FunTimes fashion, this fact ought to be explored somewhat. Why are Black people experiencing an increase in hypertension - without subtracting from the experiences of non-Afro countries?
Hypertension and Black Populations
A 1981 journal published paper by Herbert Langford shares that Black people tend to have higher blood pressure readings than White people. It also states that hypertension-related mortality is higher in Black people.
Among the more plausible causes are genetic and environmental factors. High rates of high blood pressure in Black people may be due to the genetic makeup of people of African descent.
The National Health Fund in Jamaica also puts forward that the occurrence of high blood pressure is particularly common in Black middle-aged and elderly people. Most health organizations share similar sentiments.
The abstract of Langford’s paper states:
“While there may be black-white differences of genetic origin affecting the prevalence of hypertension, at least part of [the] blood pressure difference between Black and white is probably of environmental origin.”
Interestingly, Langford states that where socio-economic factors are considered, there seems to be no difference in the occurrence of hypertension in Black populations versus White populations. Though intriguing, Langford’s findings related to socio-economic backgrounds and hypertension are outdated and have been found wanting.
Though Black people worldwide have rates of high blood pressure that are similar to that of white people, in the US, there is a dramatic difference: an estimated 41% of African Americans have high blood pressure, as compared to 27% of White Americans.
Experts think that social and economic factors, including discrimination and economic inequality, are responsible for this difference in the US.
A 2020 study on discrimination and hypertension in the African American population suggests that discrimination is a chronic stressor that may increase the risk of hypertension. The study, Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study, indicates that African Americans have a higher risk of hypertension compared with other racial or ethnic groups in the United States.
An explanation the research provides for the disparity is discrimination. They examined whether everyday discrimination, lifetime discrimination, and stress from discrimination were associated with incident hypertension and whether those associations differed according to gender, age, discrimination attribution, and coping responses to discrimination among African Americans in the Jackson Heart Study.
The results show that discrimination was self-reported by 1845 African Americans aged 21 to 85 years without hypertension at baseline for the period 2000 - 2004. Participants completed 2 follow-up study visits from 2005 to 2008 and 2009 to 2013.
The study also revealed that there was an association of incident hypertension with lifetime discrimination, but not with everyday discrimination. Participants who reported high and medium versus low lifetime discrimination had a higher risk of hypertension.
According to the American Heart Association (AHA), approximately 55% of Black people have hypertension. Also counteracting Langford’s statement, the AHA shares that historical and systemic factors play a major role in the figures about Black people and hypertension. Among the factors are adverse social determinants of health, the conditions in which people are born and live. The determinants for the development of hypertension, as stated by the AHA, include lack of access to care, lack of access to healthy foods, and other societal issues.
As for the use of hypertension-based medication, the AHA states that the lack of access to medication, and distrust of health care professionals based on historical discrimination, are among contributing factors to lower adherence to blood pressure medications.
So, not only are there external factors adding to the issue, there are internal issues that exacerbate the problem of the increased incidence of hypertension among Black people.
Addressing the Salty Issues
Though we know there is a genetic component along with non-modifiable risk factors for the development of hypertension, it is still preventable and manageable in cases where the NCD is already a problem for someone’s health. Reduce the modifiable risk factors as much as possible: exercise, adjust your diet to be more healthy and balanced (reduce salt consumption) and properly manage the stressors in your life. Take your medication if you’ve already been diagnosed with the disease, and get your health checks done if you are uncertain.
Hypertension – World Health Organization (WHO)
Hypertension – National Health Fund, Jamaica
More than 700 million people with untreated hypertension – World Health Organization
High Blood Pressure Among Black People - American Heart Association
The impact of COVID-19 on sport, physical activity, and well-being and its effects on social development - Department of Economic and Social Affairs, United Nations
Is blood pressure different in Black people? - Herbert G. Langford
Candice Stewart is a Jamaican content writer specializing in human interest feature stories. She is a web content writer, blogger, and budding podcaster.
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