Blood Pressure Equity Could Prevent CVD Events in Black Adults

A panel that took place during the American Heart Association Scientific Sessions, held November 5-7 in Chicago, Illinois, discussed how better blood pressure (BP) control was associated with lower cardiovascular disease (CVD) risk. An expert at the panel also found ways in which inequity in CVD care and BP control affected White and Black patients differently in CVD care.

Paul Muntner, PhD, gave a presentation on racial disparities in BP control and CVD. “Even after adjustments, what we see is that Black [people] are 32% more likely to die of [CVD],” he said to begin the presentation.

The racial disparity in BP control was found to have increased over time, according to Muntner. Research found that the difference in White vs Black people who had controlled BP (< 140/90 mm Hg) was 9.1 percentage points in 1999 to 2000. However, by 2017 to 2018, this difference had increased, with 66.4% of White participants having controlled BP compared with 51.7% of Black participants.

Muntner also presented data that found that the percentage of Black Americans who had hypertension and had BP control decreased from 2009 to 2020. Likewise, the percentage of Black Americans who took antihypertensive medication also decreased from 2009 to 2020 compared with White Americans, Hispanic Americans, and Asian Americans, whose levels remained similar through the same time period. Black Americans were also found to have a decreased awareness that they have hypertension.

“We see a decrease in blood pressure control. Along with that, we see some of the underlying damages of a decrease in awareness of hypertension [and] a decrease in antihypertensive medication use,” said Muntner.

Muntner went on to provide the results of a study under review for publication that evaluated social determinants of health (SDOH) and how it related to the percentage of people with uncontrolled BP. The study included 30,239 participants from all 50 states.

BP was measured twice during an at-home study visit and both measurements were averaged. Adverse SDOH that were included in this study were: having less than a high school education, having an annual household income of less than $35,000, residing in a disadvantaged neighborhood, not having health insurance, living in a health professional shortage area, and living in a high poverty zip code.

The study found that the percentage of people who had uncontrolled BP increased as the number of adverse SDOH increased. The percentage of people with uncontrolled BP with no SDOH was higher in Black Americans (25.4%) compared with White Americans (23.4%). The percentage of people with uncontrolled BP was also higher in Black Americans (40.2%) compared with White Americans (33.2%) when the participants had 4 or more adverse SDOH.

Muntner also presented data from the Jackson Heart Study. This study found that 76.4% of Black participants had controlled BP at baseline, of which 48.9% maintained it after 8 years. The Black participants who maintained BP control had a decreased risk of CVD events compared with the participants who had uncontrolled BP.

“Consistent blood pressure can be achieved and it does have benefits for cardiovascular risk reduction,” said Muntner.

BP equity could also reduce the amount of CVD events per 10 years, according to data of an in progress study presented by Muntner. It was found that 250,000 CVD events that occur through 10 years could be avoided if BP equity was achieved between Black Americans and White Americans.

Muntner concluded that the differences in BP control between Black and White Americans has increased, with SDOH making up a substantial proportion of the differences between the 2 groups. Maintaining BP control and earning BP equity in Black Americans should be the goal in the United States, as it can reduce the number of reduce CVD risk and CVD events respectively.