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Fighting Heart Disease, High Blood Pressure Among African Americans

Especially effective: DASH diet, heart drug BiDil

by Michael Haederle, AARP Bulletin, February 25, 2011

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.

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The good news, doctors say, is these health disparities can be reduced or even eliminated through a combination of lifestyle changes, medical treatment and smarter public policy.

Keith C. Ferdinand, M.D., a cardiologist who practiced in New Orleans' Lower Ninth Ward before Hurricane Katrina, says subtle genetic differences among different populations don't explain the differences in life expectancy, coronary heart disease, kidney disease, stroke and congestive heart failure.

"I think environmental or lifestyle factors are predominant," says Ferdinand, now of Atlanta, where he is a professor at Emory University and chief science officer of the Association of Black Cardiologists.

Where you live, whether there are parks nearby or whether you have access to fresh fruits and vegetables — what scientists call the "social determinants of health" — play a big role, he says.

A heart drug for African Americans

But medications can help.

Ferdinand was one of the investigators in the trial of a heart drug called BiDil, which was tested on nearly 1,150 African Americans. The study, published in 2004 in the New England Journal of Medicine, reported a 39 percent reduction in hospitalization and a 43 percent reduction in deaths compared with placebos, as well as an overall improvement in the quality of life.

The drug — a unique formulation of two older medicines — was approved by the Food and Drug Administration in 2005 with a label specifying it for use in African American patients, the first time it had done so.

"The medicine is good and it does work," Ferdinand says. "There was some push-back in terms of labeling a drug for blacks only. I actually agree with that criticism." He says the medicine shouldn't be limited to one group.

The drug's original manufacturer later sold its rights to another pharmaceutical company, making the medicine harder to obtain, but Ferdinand says it is available.

How to prevent cardiovascular disease

Doctors can treat hypertension and many heart problems with drugs, Ferdinand says, "but the overall burden of cardiovascular disease can only be curtailed by prevention. We're not going to be able to medicate, cut or scrape our way out of the epidemic of heart disease we see in the United States."

Effective prevention includes good prenatal care, proper childhood nutrition and aggressive efforts to control obesity and hypertension, Ferdinand says.

Next: Does the DASH diet work? >>

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.