Hypertension in Black Communities: Exploring Genetic and Socioeconomic Contributors

Introduction

Hypertension, or high blood pressure, elevates arterial pressure and increases the risk of cardiovascular disease, stroke, and kidney failure. In the United States, hypertension disproportionately impacts the Black community, with approximately 55% of Black adults diagnosed with the condition (American Heart Association, 2024). This report examines the genetic, environmental, and socioeconomic factors that drive hypertension within the Black community and offers strategies to enhance prevention, screening, and disease management.

This report explores the genetic, environmental, and socioeconomic factors contributing to hypertension within the Black community and proposes targeted strategies to improve prevention, screening, and management efforts.

Hypertension

Hypertension is a sustained systolic blood pressure of 130 mm Hg or higher or a diastolic blood pressure of 80 mm Hg or higher (Centers for Disease Control and Prevention, 2023). There are two classified categories of hypertension. Primary Hypertension accounts for about 90-95% of cases and has no identifiable cause. Secondary hypertension results from underlying health conditions (Centers for Disease Control and Prevention, 2023). Understanding the distinction between the different types of hypertension is essential for identifying the underlying factors contributing to hypertension and tailoring effective management strategies.

Genetic Factors

Genetics also has a role in hypertension. Some individuals have a genetic predisposition for hypertension. Studies have shown that over 1000 genetic variants are associated with blood pressure regulation (National Institutes of Health [NIH], 2016). Genes AGT, ACE, and CYB11B2 have been identified as specific genes that control blood pressure (National Institutes of Health [NIH], 2016). Genetic screening helps individuals identify their potential genetic risk for developing hypertension, allowing them to take proactive measures to mitigate that risk through lifestyle changes or medical interventions.

Environmental and Lifestyle Factors

Diet is a crucial component in controlling hypertension. Diets high in sodium are associated with increased blood pressure (Centers for Disease Control and Prevention, 2023). Reducing sodium is a simple step that can immediately impact lowering blood pressure.

Chronic stress can also lead to sustained blood pressure elevation. Stress triggers a physiological response in the hypothalamic-pituitary-adrenal (HPA) axis, which increases heart rate and cardiac output. Mental stress primarily elevates the heart rate and increases systolic blood pressure (Fontes et al., 2023). Stress management should be a priority to help lower blood pressure.

Physical inactivity contributes to both obesity and hypertension. Increasing physical activity, even slightly, can positively reduce obesity and lower hypertension. Research indicates that as little as 10 minutes of vigorous physical activity per week can help decrease hypertension (Dun et al., 2021). These findings emphasize the substantial benefits of minimal physical activity for improving cardiovascular health and effectively managing hypertension.

Socioeconomic factors, including race, age, and insurance status, significantly impact healthcare access and hypertension control. Disadvantaged groups, particularly racial and ethnic minorities, face systemic barriers that exacerbate health inequities and increase their risk of hypertension (Krishna & Franciosa, 2024). Research underscores the need for policy changes to improve healthcare access and quality to reduce health disparities, which can significantly enhance hypertension management.

Familial Aggregation of Hypertension

Hypertension often groups within families, indicating a hereditary component. First-degree relatives of individuals with hypertension have a higher risk of developing the condition (Healthline, 2021).  A combination of genetic, environmental, and behavioral factors causes familial hypertension. Hypertension involves variations in hundreds of genes, making it challenging to identify precise treatment targets.

Environmental factors within the household can also contribute to hypertension. Secondhand smoke and high-sodium diets that may be common in the household can cause an increase in hypertension (Healthline, 2021). Behavioral changes within the household can help to mitigate hypertension.

Patterns of inheritance are challenging for hypertension, as the disease is polygenic. There is a correlation in the development of hypertension based on both parents having the disease. Parental history, particularly maternal history, is a significant risk factor for hypertension, increasing the likelihood of high blood pressure by 1.89 times, and the risk triples when both parents have high blood pressure (Javanbakht et al., 2024). While genetic traits cannot be changed, understanding the impact of parental history on hypertension highlights the importance of managing controllable risk factors.

Geographic and Racial/Ethnic Connections

In the United States, the southeastern region, known as the "Stroke Belt," has a higher prevalence of hypertension. Contributing factors include diet, socioeconomic status, and limited access to healthcare. South Carolina has the highest stroke rate in the region, partly due to low levels of stroke awareness. Only 9.3% of African Americans in South Carolina can recognize stroke signs and symptoms, compared to 15.8% of the general population (Sunmonu et al., 2024). Socioeconomic disparities further exacerbate the lack of stroke knowledge in the state.

Black individuals are more likely to develop hypertension at younger ages and experience more severe forms of the condition compared to other racial groups (American Heart Association, 2024). Medical treatment options are also problematic for the Black population. Some medications are not as effective at managing hypertension in some Black people, and higher doses or secondary medication may be needed (American Heart Association, 2024). These disparities highlight the importance of equitable care and improved treatment options in the Black community.

Screening Strategies and Mitigation Approaches

Early detection and monitoring are critical for managing hypertension. To improve patient access, blood pressure monitoring options must be available in clinical and community settings.

The community can also actively participate in mitigating risk. Targeting high-risk populations within the community and providing helpful information regarding screening and treatment can help increase screening.

Recommendations for Community Engagement

Several recommendations can improve community engagement:

1. Community Education Initiatives

• Awareness Campaigns: Educational programs highlighting hypertension risks and management strategies tailored to the Black community.
• Genetic Counseling: Providing information on familial risk and the importance of regular screenings.
• Dietary education: Educating about diet interventions is also important. The DASH (dietary approach to stopping hypertension) diet is practical in helping to reduce blood pressure

2. Screening and Prevention Programs

·       Mobile Clinics: Deploying mobile health units to underserved areas to offer screenings and education.

·       Partnerships with Local Organizations: Collaborating with churches, community centers, and local businesses to promote hypertension awareness and screenings.

3. Policy and Advocacy Recommendations

• Healthcare Policy Reform: Advocating for policies that address social determinants of health and reduce healthcare disparities.
• Funding for Research: Supporting studies focused on hypertension in the Black community and striving to increase clinical trial participation for new treatments.

Conclusion

Hypertension is a multifaceted disease influenced by genetic, environmental, and socioeconomic factors. The disproportionate impact on the Black community necessitates targeted strategies for prevention and management. Understanding the genetic implications and implementing community-focused interventions tailored to the community's unique needs can reduce hypertension prevalence and improve health outcomes.

References

American Heart Association. (2024). High blood pressure among Black people. Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/know-your-risk-factors-for-high-blood-pressure/high-blood-pressure-among-black-people

Centers for Disease Control and Prevention. (2023). High blood pressure risk factors. Retrieved from https://www.cdc.gov/high-blood-pressure/risk-factors/index.html

Dun, Q., Xu, W., Fu, M., Wu, N., Moore, J. B., Yu, T., Li, X., Du, Y., Zhang, B., Wang, Q., Duan, Y., Meng, Z., Tian, S., & Zou, Y. (2021). Physical activity, obesity, and hypertension among adults in a rapidly urbanised city. International Journal of Hypertension, 2021, 1–9. https://doi.org/10.1155/2021/9982562

Fontes, M., Marins, F., Patel, T. A., de Paula, C., dos Santos Machado, L., de Sousa Lima, É., Ventris-Godoy, A., Viana, A., Linhares, I., Xavier, C., Filosa, J. A., & Patel, K. P. (2023). Neurogenic background for emotional stress-associated hypertension. Current Hypertension Reports, 25(7), 107–116. https://doi.org/10.1007/s11906-023-01235-7

Javanbakht, S., Eghbali, M., Bolourinejad, P., Sherafat, A., Khosravi, A., Hashemi, M., & Sarrafzadegan, N. (2024). Maternal or paternal history: Which one plays more important role in developing hypertension? ARYA Atherosclerosis Journal, 17(1). https://doi.org/10.22122/arya.v17i0.2263

Krishna, K., & Franciosa, M. (2024). Addressing hypertension disparities via systems dynamics: Insights from community health connections. Cureus. https://doi.org/10.7759/cureus.68763

National Institutes of Health. (2016, September 20). The genetics of blood pressure. https://www.nih.gov/news-events/nih-research-matters/genetics-blood-pressure

Sunmonu, N., Malek, A. M., Jenkins, C., & Hyacinth, H. I. (2024). Predictors of stroke literacy among african americans in the "buckle of the stroke belt". Frontiers in Stroke, 3. https://doi.org/10.3389/fstro.2024.1331085