“Something wrong?
Yeah. It’s just too bad you don’t know what it is...”
It’s
unfortunate that this line written by Oscar nominated writer and
director of the “Boyz in the Hood”, is a reality for so many United
States (U.S.) adults. But for over 50% of African American men and women
this is not a movie, it’s real life. John Singleton, the famed director
succumbed to the complications of high blood pressure and died from a
massive stroke, he was only 51 years old. Too many people in communities
of color do not know they have high blood pressure, also called
hypertension. Singleton was the first African American and youngest
filmmaker to be nominated for an Academy Award for best director. He had
so much more to contribute; his early death could have been prevented.
AN IMPORTANT HEALTH ISSUE IN THE BLACK COMMUNITY
We want to help you to
understand hypertension and what can be done to manage or prevent it for
yourself and your family. Hypertension is a chronic disorder of
consistent high blood pressure with ranges above normal (see chart). The
Center for Disease Control (CDC) states an astounding statistic, that
half of all United States (U.S.) adults have high blood pressure. Only 1
in 4 adults have high blood pressure under control. This means 3 in 4
U.S. adults with high blood pressure or a staggering 75% do not have it
under control. Could that be you? Maybe you don’t even know.
High
blood pressure develops and increases slowly over time; the signs and
symptoms that would get your attention do not occur until blood pressure
ranges are extreme, possibly resulting in hospitalization and/or death;
this is why it’s often referred to as the silent killer. “You can’t
feel your blood pressure, so you really need to have it checked,” states
Dr. Mark Friedberg, an internal medicine physician at Mass General
Hospital and Senior Vice President of Performance Measurement and
Improvement at Blue Cross Blue Shield of Massachusetts. However some
people whose blood pressure is extremely high may experience symptoms
such as severe headaches, chest pain, dizziness, difficulty breathing,
nausea, confusion, buzzing in the ears, nosebleeds or other symptoms.
Over time, high blood pressure can cause damage to your heart, brain and
kidneys. In 2021, the CDC stated that over 691,000 deaths in the U.S.
were primarily caused by hypertension (high blood pressure) or its
complications. These numbers emphasize high blood pressure is truly a
silent public health crisis.
What is blood pressure?
Each
time your heart beats, it pumps blood throughout your body and through
your arteries. The pressure your blood puts on the arteries while
circulating in the body is your blood pressure.
How can you find out what your blood pressure numbers are?
It
is a routine and painless measurement collected during a doctor’s
visit. Your local pharmacy can also measure your blood pressure.
According to Dr. Friedberg, “The best way to prevent problems is to make
sure your blood pressure is checked regularly (at least once a year) by
a medical professional. It’s important!”
How is it measured?
When
you have your blood pressure checked, the results will include two
numbers. The top number is your systolic pressure, the pressure your
heart exerts while pumping blood. The bottom number is your diastolic
pressure, the pressure your heart exerts when at rest between beats.
Blood pressure is measured using both numbers, the systolic pressure
followed by the diastolic pressure measured in units of milliliters of
mercury (mm Hg).
What is normal blood pressure?
According
to the American College of Cardiology and American Heart Association
(AHA) if the first number called systolic blood pressure is less than
120 mm Hg, and the second number called diastolic blood pressure: is
less than 80 mm Hg, that is considered a normal blood pressure. Each
time you have your blood pressure checked, the results will include two
numbers and your numbers will fall into one of these categories. For
example, 112/73 mm Hg or “112 over 73” is considered a normal blood
pressure.
Nurse Practitioner and Researcher, Beth Israel Deaconess Medical Centers
What if it is higher?
The
first stage of hypertension starts when the first number systolic is
between 130-139, and/or the second number diastolic, is between 80-89.
The second stage of hypertension is indicated when the first number
systolic is 140 or higher and/or when the second number diastolic is 90
or higher.
Importantly, both the CDC and the AHA report the rate of hypertension as higher in non-Hispanic black adults (56%) than in
non-Hispanic white adults (48%), Asian adults (46%), or Hispanic adults
(39%). Black people develop hypertension earlier in life and have higher
rates of more severe high blood pressure ranges than other ethnic
groups.
The good news is that high blood pressure can be prevented, managed and controlled. There are many initiatives to help people
with an early hypertension diagnosis as well as those individuals who
struggle to control more acute high blood pressure. Dr. Ruth-Alma
Turkson-Orcan, Nurse Practitioner and Researcher with the Beth Israel
Deaconess Medical Centers encourages people to reframe how we think and
talk about hypertension. “Think of it more as a management versus a
treatment or cure…sticking with the meds, checking blood pressures at
home is really the key to getting to the numbers at your target goal
along with your provider.”
It’s important to recognize
the risk factors that impact you in order to address the ones that can
be controlled and be mindful about those you cannot. This is especially
important for individuals with families and teaching them preventative
habits, early.
HEALTH INFORMATION BROUGHT TO YOU BY BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
What are the risk factors for hypertension?
There are two kinds, 1) risk factors that are beyond your control and 2) risk factors that can be controlled to help mitigate the severity or possibly even prevent hypertension.
There are fixed risk factors that you cannot change or control, but should be aware of.
FAMILY HISTORY
According
to Dr. Friedberg, “If your parents had high blood pressure, there’s a
good chance you might get it,” he said. “Most patients require
medication, and it’s not because of anything they did or didn’t do.
People shouldn’t feel guilty or ashamed about having high blood
pressure.”
AGE
The older we get the less elastic and flexible our blood vessels become making the pressure of the blood pumping more intense.
GENDER
Men
are more likely to develop high blood pressure in their early years,
before age 60. Women are more likely to develop high blood pressure
later, age 60 and older due to hormonal decreases in estrogen from
menopause.
RACE
African
Americans not only have higher incidence rates of high blood pressure
among all ethnic groups, they have a higher rate of the severity. It is
not because someone is Black or Hispanic alone that they are at higher
risk for high blood pressure, but other systemic factors like structural
racism that contribute to this health inequity.
There
are several risk factor areas where you can work to control high blood
pressure and create better habits for yourself. And, possibly even
prevent high blood pressure from starting.
DIET
A
focus on making healthy food choices can be a powerful first step to
managing high blood pressure. Reduce salt and sugar from your diet.
People who suffer from diabetes are also at a higher risk for high blood
pressure. 12% of African Americans have diabetes, a chronic health
condition that requires close monitoring. Diabetes directly affects how
the body can successfully convert food into energy. If your body does
not have enough energy, it affects how your body functions including
major organs like the heart, brain and kidneys.
ALCOHOL CONSUMPTION
Regular
use of alcohol can lead to high blood pressure. The American Heart
Association (AHA) recommends that if you do consume alcohol that you do
so responsibly. Alcohol consumption increases dehydration a major
contributor to elevated blood pressure. The CDC recommends increasing
water consumption instead. People with high blood pressure should
attempt to drink 8 – 15 cups of water per day, based upon their thirst.
CHOLESTEROL
It’s
important to note more than half of adults with high blood pressure
have high (LDL) cholesterol. Having too much cholesterol can create
plaque in your arteries causing arteries to become stiff and narrow,
increasing your blood pressure. 60% of individuals with high blood
pressure also have high cholesterol. Your cholesterol levels can be
managed with vigilance and support from your medical team.
EXERCISE
Daily
activity is recommended. Walking and/or taking classes at your local
gym, local Y, or utilizing other fitness centers will prevent large
fluctuations in weight. Preventing obesity is crucial. Review your
health insurance coverage policy as many insurers offer incentives and
discounts. Health insurance plans like those offered by Blue Cross Blue
Shield
of Massachusetts have made it a priority to promote health and
wellness. In fact, yearly wellness visits are covered at $0 cost, these
include routine screenings for many chronic illnesses like high blood
pressure. Many of their members are eligible up to $300 in fitness and
weight-loss reimbursements including health club membership and classes
with weightloss programs like WW (formerly known as Weight Watchers®) to
name a few. Check your health insurance to review your benefits.
DR. LEONOR FERNANDEZ
Health Equity Medical Director
Beth Israel Lahey Health
In
support of the broader community, Blue Cross has served as Bluebikes’
title sponsor, since May 2018, helping to enhance access to the public
bike share system in Greater Boston that serves as a safe and
sustainable public transportation option and also helps communities stay
active in an affordable way.
TOBACCO
Smoking/vaping
consumption damages and weakens blood vessels. It not only greatly
increases your risk of high blood pressure but also heart disease: like a
heart attack and stroke.
STRESS
While
some moderate stress is ok, too much stress can increase blood
pressure. The ability to negotiate stress positively directly affects
our health outcomes. Our bodies physically respond to short-lived stress
with an increase in heart rate, constriction of blood vessels and a
temporary increase in blood pressure. However, chronic stress or
long-term stress affects the physical and mental body. The path to
reducing stress whether short-term or chronic is stress management. Dr.
Leonor Fernandez, Health Equity Medical Director at Beth Israel Lahey
Health (BILH) agrees, “we live in a stressful world.” Physical exercise
and staying socially connected to friends and family helps. Building a
resilient mind is the foundation to creating a healthier body.
A Call To Action
In
2020, then U.S. Surgeon General, Dr. Jerome Adams issued a call to
action by highlighting hypertension as public health crisis. Dr. Adams
advocated to take a team approach, provider, community and patient all
working together.
Blue
Cross is answering that call to action. For Cecilia Flores-Rodríguez,
PhD, Senior Program Manager for Provider Performance and Equity, “Blue
Cross takes pride in its deep commitment to address health equity
through its collaborative partnership with provider organizations as
they implement hypertension initiatives to improve patient outcomes.”
This
commitment led Blue Cross to set up a collaboration with health care
provider groups Equity Action Community (EAC) to address health equity
and improve patient health through a team approach as recommended by
former U.S. Surgeon General Adams. Provider organizations in the EAC
have been able to spot inequities in health outcomes, like high blood
pressure, and then move to identify the root causes of the problem. Dr
Elizabeth Molina Ortiz, internist and Chair of Atrius Health Equity
committee said, “We identified a persistent trend of our White patients
reaching their blood
pressure goals at a higher percentage than our Black patients.” Atrius
Health would not have known this trend without racial and ethnicity
demographic information about their patients. This sentiment is echoed
by Dr. Fernandez who talks passionately about the relationship between
primary care provider and patient. Primary care providers are by no
means perfect, but equity champion Dr. Fernandez is clear that training
doctors to have an “alertness of the physical and spiritual presence of
their patients in the room” is powerful. While this relationship is
foundational to our health care systems it requires the whole team;
nurses, clinicians, and front desk staff to build relationships of
trust. Coupled with the power of data, Dr. Fernandez further explains
these metrics help her team look at patient populations not only by race
and ethnicity but also by language, and zip codes “these results help
us understand where we are doing well, and where we are not doing well.”
Their team has also been able to
distribute blood pressure cuffs to patients along with proper training
so that they may have more autonomy in their care.
CECILIA FLORES-RODRÍGUEZ, PHD
Senior Program Manager for Provider Performance and Equity
Blue Cross Blue Shield of Massachusetts
Similarly,
data allowed Atrius, with the support of Blue Cross, to meet
individualized patient needs with game changing interventions like
telehealth appointments to eliminate transportation challenges and
providing blood pressure cuffs for use at home for their uncontrolled
high blood pressure patients.
We
can all start to take control of high blood pressure by working with
our doctors and clinicians. Contact your health insurance provider —
research and know your benefits and/or reimbursements to take classes
for nutrition, weight loss, and to stay active. Find out what resources
they offer for prevention and/or treatment, for example you can use a
blood pressure cuff at home to monitor your own blood pressure; some
physicians can track your blood pressure numbers electronically through
technology. You can also measure your blood pressure regularly at a
local pharmacy. Stay connected and collaborate with your doctor around
medication usage. Patient involvement in a partnership with their health
care providers translates to positive health outcomes. Dr Leonor
Fernandez, Health Equity Medical Director at BILH enthusiastically
shares that “treatment of hypertension is a success story ... if we are
able to engage our patients.”
John
Singleton’s family wished he did not secretly struggle with
hypertension. They wished, just like the characters he brought to life
on screen, that he would have chosen to live differently. While the
numbers let us know that hypertension is a reality for most African
Americans, the use of blood pressure cuffs at home, medications, and
effective partnerships with trusted physicians will save lives.