Higher risk for Black women under 35 with high blood pressure

Hypertension, or high blood pressure, is more prevalent in Black adults in the United States, so researchers said it wasn’t surprising to find a high incidence in study participants.

Dr. Hugo Aparicio, the lead study author and an associate professor of neurology at Boston University Chobanian & Avedisian School of Medicine, told Medical News Today that 10% of study participants younger than 45 and nearly 40% aged 45 to 64 had high blood pressure.

“However, the most concerning finding was that risk of stroke from an early age, such as the second or third decades, appeared to impart the highest risk of a stroke over the period of follow-up,” he explained.

Experts note that since high blood pressure is a major risk factor for stroke, it stands to reason that younger people with hypertension could have a stroke at a relatively young age.

“There is often the misconception that this heightened risk of stroke isn’t really apparent until older age and therefore healthcare providers are often less concerned when high blood pressure is identified in younger people,” said Michelle O’Donoghue, an associate professor at Harvard Medical School and McGillycuddy-Logue Distinguished Chair in Cardiology at Brigham and Women’s Hospital in Boston who was not involved in the research.

“Although the risk of mid-life stroke is relatively low, this study importantly highlights that early onset of hypertension is a very important predictor of this event, and stroke can occur in middle age,” O’Donoghue told Medical News Today.

Aparicio said he and his colleagues attempted to account for various factors, including a participant’s region of the country and socioeconomic status, along with risk factors such as excess body weight, smoking, and diabetes.

Even after accounting for this, the researchers said they still continued to see the elevated risk of stroke with a history of hypertension across age groups.

“Factors such as psychosocial stressors, or experience with racial discrimination, have been correlated with a higher risk of cardiovascular disease and stroke,” Aparicio said. “Hypertensive disorders or onset associated with pregnancy have also been related to stroke, specifically among Black women, who have higher rates of these pregnancy complications.”

O’Donoghue points out that Black men and women are undertreated for high blood pressure and cardiovascular disease for reasons that are likely multi-faceted.

“It can be challenging in many regions to find a primary care doctor for routine health maintenance,” she said. “Challenges with access to medications, challenges with adherence and attending doctors visits are just some of barriers that we don’t spend enough time thinking about in our conversations with patients.”

A genetic factor that also uniquely affects Black people is lipoprotein (a), a type of cholesterol that’s associated with cardiovascular disease and stroke.

“We know that average [lipoprotein (a)] levels may be more than threefold higher in Black persons, yet this under-recognized risk factor is rarely being assessed in clinical practice,” O’Donoghue explained.

While there’s a genetic factor to high blood pressure, other aspects can be controlled to lower one’s risk of developing hypertension, along with heart disease and stroke.

This strategy can start with a doctor’s visit, where blood pressure tests and screening can help people get a handle on their overall health.

“Make sure that even mildly elevated blood pressures are tracked and addressed through prevention efforts like changes in diet or exercise, quitting smoking, and developing better sleep habits,” advised Aparicio. “To reduce risk of stroke, also pay attention to managing specific risk factors like excess body weight, abnormal blood cholesterol levels, and elevated blood pressure.”

Aparicio notes that these findings, along with other data related to Black people and hypertension, underlines the importance for both doctors and patients to pay special attention to screening.

“Neither hypertension nor risk of stroke should be perceived as [just] problems of older women,” he said. “We also need healthcare policy changes that emphasize, promote, and fund primary prevention because for Black women having a stroke at middle age, it is often too late.”