Fighting Heart Disease, High Blood Pressure Among African Americans

Public health experts have known for some time that heart disease and hypertension exact a heavy toll on African Americans, although they haven't always agreed on what to do about it.

African American adults are 30 percent more likely to die from heart disease than non-Hispanic whites, according to federal statistics. They are 40 percent more likely to suffer from high blood pressure than whites, less likely to have their blood pressure under control and three times as likely as whites to die from hypertension-related illnesses.

DASH diet works best for blacks

Diet is especially important in controlling high blood pressure, says Nisa Maruthur, M.D., assistant professor of medicine at the Johns Hopkins University Medical School. She evaluated long-term heart attack risk among 436 people assigned to one of three diet plans.

Those on the DASH diet (it stands for Dietary Approaches to Stop Hypertension) saw an estimated 18 percent lower risk of heart attack over 10 years, compared with people eating standard American fare, she found. The DASH diet includes nine to 11 servings of fruits and vegetables per day, plus two servings of low-fat dairy.

The diet worked particularly well for African American participants, who made up nearly 60 percent of the study subjects, Maruthur found. "They had around a 22 percent risk reduction" compared with a similar group not on the diet, she says.

How barbershops help

Knowing that high blood pressure may lead to a heart attack or stroke, Ronald Victor, M.D., a cardiologist and hypertension expert at Cedars-Sinai Medical Center in Los Angeles, trained barbers in 17 black-owned Dallas barbershops to take blood pressure readings from their patrons. In some shops, customers with elevated blood pressure were urged to get follow-up care from doctors, while in others they simply received informational pamphlets.

Victor's study found that 20 percent more of the men whose barbershops promoted medical follow-up got their blood pressure under control, compared with an 11 percent increase in the pamphlet-only barbershops.

The study showed that people respond to positive health messages from their peers, Victor says. "The idea is to make health surveillance and follow-up not only acceptable but desirable."

Clyde Yancy, M.D., chief of cardiology at Northwestern University's Feinberg School of Medicine and immediate past president of the American Heart Association, believes hospitals could provide better treatment for their African American patients by committing to a "quality-driven" approach, in which all patients can expect to receive the same high standard of care.

Meanwhile, many of the heart health disparities facing African Americans are linked to higher rates of obesity, diabetes and tobacco use. "Honestly, if we had a truly effective obesity initiative in this country, and people reduced their sodium intake," then, he says, disease could be reduced as well.

A final piece of the puzzle involves better communication between doctors and their patients. "If the patient doesn't believe that the provider 'gets it' or understands their experience, they may shut down. They may ignore the advice," he says. Taken together, Yancy says, "all those things wind up having an impact on health. It's intuitive, but it hadn't been so evident as it is now."

Michael Haederle is a freelance writer whose work has appeared in People, the New York Times and the Los Angeles Times.