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Black Women With High Blood Pressure Before Age 35 May Have Triple The Risk Of A Stroke
Research Highlights:
Embargoed until 4 a.M. CT/5 a.M. ET, Thursday, Feb. 1, 2024
DALLAS, Feb. 1, 2024 — Black women who develop high blood pressure before age 35 and are on medication for hypertension may have triple the odds of having a stroke, and those who develop high blood pressure before age 45 may have twice the risk of suffering a stroke, according to a preliminary study to be presented at the American Stroke Association's International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.
"This research was motivated by the glaring disparity I have seen in my own practice. Strokes are occurring at younger ages among my patients who identify as Black and among women," said the study's lead author Hugo J. Aparicio, M.D., M.P.H., an associate professor of neurology at Boston University Chobanian & Avedisian School of Medicine. "Early onset stroke, particularly at midlife, is even more tragic because these patients often have families or are caretakers for sick family members."
"In addition, early onset stroke at a younger age is associated with an increased risk of dying, as well as a burden of physical disability that creates many problems for stroke survivors and their families as they try to re-integrate into their normal lives and return to work," Aparicio said.
According to the American Heart Association's Heart Disease and Stroke Statistics 2024 Update, the rate of high blood pressure in Black adults in the United States is among the highest in the world. In the U.S., about 58% of Black women have high blood pressure, while 43% of white women, 38% of Asian women and 35% of Hispanic women have high blood pressure.
Researchers investigated how the development of high blood pressure at a younger stage in life among Black women may influence the risk of a potentially disabling stroke. They examined data from the Black Women's Health Study, a study of 59,000 Black women from across the United States who have been followed since 1995 via questionnaires once every two years.
Researchers compared participants with and without treatment for hypertension before age 45, between ages 45-64, and within 10-year age intervals from 1999 to 2019.
The analysis found that stroke occurred in 1,485 participants (3.2%) during up to 23 years of follow-up. Compared to Black women with no history of hypertension treatment:
"We expected to see an association between having high blood pressure at a younger age and having a stroke during midlife and later life, however, we were surprised and concerned to see the magnitude of the relationship, especially for women who were taking antihypertension medications before age 35," Aparicio said.
"This was striking because we had the ability to adjust or account for many important factors in this longitudinal study, including clinical factors like smoking, body weight and diabetes status; and neighborhood socioeconomic status, which is estimated using zip code data. We also adjusted for people living in certain geographic regions in the U.S. Where stroke is more common and where stroke mortality is higher, mainly clustered in the Southeast and Mid-Atlantic regions of the country, or the so-called Stroke Belt."
Study details and background:
Study limitations include that researchers were unable to obtain medical records for all participants who reported a stroke, and not all stroke events may be reported by the participants. Aparicio said self-reported high blood pressure diagnoses were proven reliable in previous analyses of the Black Women's Health Study.
"My hope is that health care professionals are persuaded to pay special attention to high blood pressure screening and treatment over the life course for African American women, such as during child-bearing years and both before and at the start of middle age. Health care policy changes are needed so that primary prevention is promoted and funded because by the time a Black woman has a stroke at middle age, it is often too late," Aparicio said.
"While many factors contribute to early-onset hypertension resulting in an alarming stroke burden among Black women, an understudied component is the cumulative impact of multiple psychosocial stressors that likely disproportionately affect Black women compared to women from other racial and ethnic groups regardless of socioeconomic status. The impact of these stressors also likely affect the ability of Black women to receive and maintain holistic care," said the American Heart Association's Immediate Past President Michelle A. Albert, M.D., M.P.H., FAHA, who is also the Walter A. Haas-Lucie Stern Endowed Chair in Cardiology and professor of medicine at the University of California at San Francisco, director of the CeNter for the StUdy of AdveRsiTy and CardiovascUlaR DiseasE (NURTURE Center) and associate dean of admissions at the University of California, San Francisco School of Medicine. Dr. Albert was not involved in the study.
Co-authors, disclosures and funding sources are listed in the abstract.
Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association's scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association's overall financial information are available here.
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About the American Stroke Association
The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.Org. Follow us on Facebook, X.
Disclaimer: AAAS and EurekAlert! Are not responsible for the accuracy of news releases posted to EurekAlert! By contributing institutions or for the use of any information through the EurekAlert system.
What Is High Blood Pressure? Symptoms, Causes, Diagnosis, Treatment, And Prevention
The following can increase your chances of developing high blood pressure.
Age The risk of high blood pressure increases as you age; the older you are, the more likely you are to develop high blood pressure. Blood vessels gradually lose their elasticity over time, which can contribute to high blood pressure.[2]
The risk of prehypertension and high blood pressure has been increasing in recent years in young people too, including children and teens, possibly because of the rise in obesity in these populations.[3]
Race High blood pressure is more common in Black American adults than in white, Asian, or Hispanic American adults.[4]
Gender Men are more likely than women to be diagnosed with high blood pressure, until age 64.[2] However, after that age, women are more likely to have high blood pressure.
Family History Having a family history of high blood pressure increases your risk, as the condition tends to run in families.[2]
Weight The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. When the volume of blood pumping through your blood vessels increases, the pressure on your artery walls also rises.[5]
Physical Activity People who are not active tend to have a higher heart rate and higher blood pressure than those who are physically active.[5] Not exercising also increases the risk of being overweight.
Tobacco Use When you smoke or chew tobacco, your blood pressure rises temporarily, partly from the effects of nicotine. Moreover, chemicals in tobacco can damage the lining of your artery walls, which can cause your arteries to narrow, increasing your blood pressure.[5] Being exposed to secondhand smoke may also increase your blood pressure.
Diet What you choose to eat (and not to eat) can increase your risk of hypertension:[5]
[6]
Stress Being under intense stress can lead to a temporary increase in blood pressure.[2] Moreover, if you try to cope with stress by overeating, using tobacco, or drinking alcohol, all of these can contribute to high blood pressure.
Chronic Conditions Having kidney disease, sleep apnea, or diabetes can affect blood pressure.[5]
Pregnancy Being pregnant can cause an increase in blood pressure. High blood pressure occurs in 1 in every 12 to 17 pregnancies in women ages 20 to 44.[7]
Birth Control Women who take birth control pills have a greater risk of developing high blood pressure. It's more likely to occur when women are overweight, have had high blood pressure during a previous pregnancy, have a family history of blood pressure, smoke, or have mild kidney disease.[8]
Causes of Secondary HypertensionWhen high blood pressure arises suddenly due to an identifiable condition, it's called secondary hypertension.
The following conditions can lead to secondary hypertension, including:[5]
Medications that you take to control other health conditions, such as arthritis, epilepsy, or allergies, can cause your blood pressure to rise.
They can also interfere with the ability of drugs used to keep blood pressure down.
The drugs below are some of the ones that may negatively affect blood pressure.[9]
Pain Medications Common pain and anti-inflammatory medicines can lead to water retention, which can increase blood pressure and create problems with the kidneys.
Examples include:
Antidepressants These drugs work by changing the body's response to chemicals that affect mood. That can also lead to an increase in blood pressure.
Examples of antidepressants that may elevate blood pressure include:
Decongestants These medicines, which include common cough, cold, and allergy drugs, are known to raise blood pressure and to alter the effectiveness of blood pressure medication.
Examples include pseudoephedrine (Sudafed, Contac) and phenylephrine (Sudafed PE).
Hormones Birth control pills can also affect blood pressure. Women who take birth control pills usually experience a small rise in systolic and diastolic blood pressure (the top and bottom numbers that are determined when you get your blood pressure checked).
Hormone therapy used to relieve symptoms of menopause can also cause a small rise in systolic blood pressure.
If you know you have high blood pressure but are considering hormone therapy, talk with your doctor about the risks and benefits of undergoing hormone therapy, as well as the best ways to control your blood pressure.
Additionally, some recreational and illegal drugs, such as cocaine, ecstasy (MDMA), and amphetamines, are also known to increase blood pressure.
Swapping Salt For This Substitute May Reduce Your Risk Of High Blood Pressure By 40%, Study Finds
It may be time to remove the salt shaker from your table. New research shows that using salt substitutes may effectively reduce your risk of high blood pressure and boost heart health.Video above: Blood pressure is best lowered by these exercisesThe study published in the Journal of the American College of Cardiology looked at how replacing regular table salt with a potassium-enriched salt substitute might impact blood pressure. It included over 600 Chinese adults who did not previously have high blood pressure. Researchers randomly assigned half of the participants to consume regular salt, and the other half to use a salt substitute.Typical table salt is almost entirely sodium chloride. The salt substitute used in the study contained around one-third less sodium chloride than table salt. The salt substitute also contained 25% potassium chloride, which doesn't raise blood pressure, the study noted.After two years, researchers found that those using the salt substitute were 40% less likely to develop high blood pressure or hypertension, compared to those using regular salt. People in the salt substitute group did not have an increased risk of low blood pressure episodes, or hypotension. These findings suggest that incorporating salt substitutes into your diet could potentially reduce the risk of developing hypertension and associated cardiovascular diseases without introducing additional health risks like low blood pressure.The goal of a salt substitute is to replace the concerning component of salt (sodium) with another mineral so that it still looks and tastes like salt but can offer a way to reduce risk and cut back on a person's salt intake, explains Sadiya S. Khan, M.D., professor of cardiovascular epidemiology at Northwestern Medicine's Feinberg School of Medicine and American Heart Association Go Red for Women volunteer. "This is very important because we know that salt is an important driver of poor heart health and risk for high blood pressure," she notes.Prior studies have demonstrated that eating less sodium lowers blood pressure. However, it is really hard to cut out sodium from a person's diet, says Dr. Khan. And cutting it out completely could also be detrimental by causing low blood pressure. So, this has raised the question of whether we can replace sodium with an alternative salt or salt substitute. Although there are clear benefits of using salt substitutes for many with high blood pressure, more research needs to be done about its effects on those with normal or healthy blood pressure as a prevention method for high blood pressure, says Dr. Khan. "There are also risks to using salt substitutes for people with conditions that impair potassium excretion, such as chronic kidney disease or heart failure, including arrhythmias and sudden cardiac death," she notes.It's also important to note how different countries and different populations consume most of their sodium intake, adds Dr. Khan. "For example, in China, most of the sodium intake comes from adding salt in the process of cooking. In the U.S., nearly 70% of our sodium intake comes from consuming commercially processed food products or restaurant foods," Dr. Khan notes. So this study is not necessarily indicative of the general population.There may be other health benefits from a salt substitute that includes potassium, but the important thing in a healthy diet is balance, says Dr. Khan."We need to ensure that all major macronutrients are being achieved in a good balance," she advises. A heart-healthy balanced diet, like the Mediterranean diet, is important for overall heart health and one swap can't eliminate the importance of the other parts of the diet as well as the overall caloric intake for a healthy diet, she explains.
It may be time to remove the salt shaker from your table. New research shows that using salt substitutes may effectively reduce your risk of high blood pressure and boost heart health.
Video above: Blood pressure is best lowered by these exercises
The study published in the Journal of the American College of Cardiology looked at how replacing regular table salt with a potassium-enriched salt substitute might impact blood pressure. It included over 600 Chinese adults who did not previously have high blood pressure. Researchers randomly assigned half of the participants to consume regular salt, and the other half to use a salt substitute.
Typical table salt is almost entirely sodium chloride. The salt substitute used in the study contained around one-third less sodium chloride than table salt. The salt substitute also contained 25% potassium chloride, which doesn't raise blood pressure, the study noted.
After two years, researchers found that those using the salt substitute were 40% less likely to develop high blood pressure or hypertension, compared to those using regular salt. People in the salt substitute group did not have an increased risk of low blood pressure episodes, or hypotension. These findings suggest that incorporating salt substitutes into your diet could potentially reduce the risk of developing hypertension and associated cardiovascular diseases without introducing additional health risks like low blood pressure.
The goal of a salt substitute is to replace the concerning component of salt (sodium) with another mineral so that it still looks and tastes like salt but can offer a way to reduce risk and cut back on a person's salt intake, explains Sadiya S. Khan, M.D., professor of cardiovascular epidemiology at Northwestern Medicine's Feinberg School of Medicine and American Heart Association Go Red for Women volunteer.
"This is very important because we know that salt is an important driver of poor heart health and risk for high blood pressure," she notes.
Prior studies have demonstrated that eating less sodium lowers blood pressure. However, it is really hard to cut out sodium from a person's diet, says Dr. Khan. And cutting it out completely could also be detrimental by causing low blood pressure. So, this has raised the question of whether we can replace sodium with an alternative salt or salt substitute.
Although there are clear benefits of using salt substitutes for many with high blood pressure, more research needs to be done about its effects on those with normal or healthy blood pressure as a prevention method for high blood pressure, says Dr. Khan.
"There are also risks to using salt substitutes for people with conditions that impair potassium excretion, such as chronic kidney disease or heart failure, including arrhythmias and sudden cardiac death," she notes.
It's also important to note how different countries and different populations consume most of their sodium intake, adds Dr. Khan.
"For example, in China, most of the sodium intake comes from adding salt in the process of cooking. In the U.S., nearly 70% of our sodium intake comes from consuming commercially processed food products or restaurant foods," Dr. Khan notes. So this study is not necessarily indicative of the general population.
There may be other health benefits from a salt substitute that includes potassium, but the important thing in a healthy diet is balance, says Dr. Khan.
"We need to ensure that all major macronutrients are being achieved in a good balance," she advises.
A heart-healthy balanced diet, like the Mediterranean diet, is important for overall heart health and one swap can't eliminate the importance of the other parts of the diet as well as the overall caloric intake for a healthy diet, she explains.
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