What Black Adults Need to Know About Stroke Risk

Preventing and recognizing signs of the medical emergency are key

Doctor and patient using digital tablet in office

LWA/Dann Tardif

Joyce Sampson,

AARP

En español

Published September 21, 2022

Richard Horton, an insurance broker in Pasadena, California, walked around for at least a decade of his middle-aged years with blood pressure hovering around 178/95 millimeters of mercury (mm Hg, the unit of measurement for blood pressure), dangerously close to a hypertensive crisis and a sure candidate for stroke. For comparison, what’s considered a normal level for most adults is less than 120/80 mm Hg.

Diagnosed with high blood pressure during a routine physical exam in the late 1990s, he wasn’t worried. Per his doctor’s orders, he returned for weekly follow-up visits to monitor changes. The numbers didn’t improve. But Horton, who is Black, didn’t receive treatment.

“At that point,” he recalls, “the doctor said that in the medical field, we find that African Americans have a higher blood pressure rate than whites and others. Because of that fact, we’re not going to push medication, but we’ll keep an eye on your pressure. If it gets much higher, then we’ll prescribe medication.” (Research shows Black patients often aren’t offered the full range of appropriate treatments when it comes to blood pressure management.)

In August 2011, while preparing to close a big sale, Horton climbed out of bed and walked into the bedroom wall. He was having a stroke. During a hospital stay that lasted over two months, Horton, who was then 55, had a second stroke. He couldn’t walk, talk or use his left arm.

A growing gap

Nearly 800,000 people in the U.S. have stroke each year — this happens when a blood vessel that carries oxygen and nutrients to the brain is either blocked or bursts — and Black adults bear a disproportionate burden of those cases.

In fact, the risk of stroke among Black Americans is nearly twice as high as it is for whites, data from the Centers for Disease Control and Prevention (CDC) shows; some studies suggest it's even higher. Black Americans are also much more likely to die from stroke, and those who do survive are more likely to be disabled than stroke survivors in other racial groups.

The reasons behind these troubling trends are both simple and complex, says cardiologist Donald Lloyd-Jones, M.D., chair of the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine, and past president of the American Heart Association (AHA).

There are several risk factors for stroke — high blood pressure, heart disease and diabetes, to name a few— that are common in the Black community. In fact, over half of Black adults have high blood pressure, according to the AHA, which can damage the blood vessels and pave the way for a blockage.

Genetics may play a role in this particular risk factor. Researchers at the National Institutes of Health found in a 2019 study that variants in a gene may be associated with high blood pressure among Black adults.

“It is fair to say that people who have a larger ancestry of African genes in their genetic makeup are more prone to higher blood pressure levels, particularly when you put them in an environment like ours where there’s too much sodium in the food supply,” Lloyd-Jones says. “That’s a bad combination, no question. And that’s part of what drives the higher blood pressures in the Black community in this country.”

Adding to the mix is sickle cell anemia and sickle cell disease, a rare blood disorder that typically affects people of African descent. Because sickled cells can clump together and block blood vessels, the inherited condition is also a risk factor for stroke, the AHA says. Even carrying a copy of the gene that can cause the disease (called sickle cell trait) has been linked to increased stroke risk.

But more than genetics is at play. So-called social determinants of health — or conditions that make up the environment in which you live — have a lot to do with the stroke disparity too, Lloyd-Jones explains. A 2022 report from the Kaiser Family Foundation found Black Americans fared worse than their white peers across many social determinants, including personal transportation and food access.

“We can trump the genetics if we have a healthier food supply, or if we allow people to access healthy foods [and] to access health care,” Lloyd-Jones says. “It doesn’t have to play out that way.”

Healthy food wasn’t always accessible for Mark Moore, a stroke survivor, author and now philanthropist living in Northern Virginia. Growing up with seven siblings in Jamaica, Queens, New York, Moore’s parents didn’t drive, and the closest grocery store was poorly stocked.

“That local store that we walked to was not filled with fresh fruits and vegetables. They had honey buns and Ring Dings and all those kinds of things, so that’s what we purchased. If you’re eating that kind of food, the tendency is you’re more likely to develop high blood pressure, high cholesterol, diabetes and obesity” — all factors that increase risk of stroke, says Moore, who suffered two strokes in 2007 and is now 61.

Research shows that food deserts — or areas where it’s hard to find fresh, healthy foods — are more common in minority neighborhoods. What’s more, Black children are almost three times more likely to live in a food-insecure household than white children, according to the nonprofit Feeding America.

“When we talk about health disparities, people sometimes say we’re blaming someone. But it’s not a matter of blame, it’s a fact. This is where we are,” Moore adds.

Racism’s impact on health

Racism can also play a role. Studies show that both interpersonal and structural discrimination are linked to poor health outcomes among Black Americans. And one reason has to do with “the burden of chronic stress” that racism inflicts, says Michael D. Brown, chair of the Department of Kinesiology at the University of Maryland College Park, whose research focuses on hypertension, vascular health and exercise in African Americans.

Scientists say that when the human body faces extreme stress, it releases hormones and neurotransmitters such as norepinephrine, epinephrine and cortisol. Repeated release of these substances can lead to secondary effects such as high blood pressure. Stress can also trigger inflammation, which has been linked to stroke risk.

“What’s unique to Blacks in this country — maybe not unique, but it’s persistent and prevalent — is kind of this racialized stress, perceived stress from racial discrimination and marginalization that Blacks in this country endure on a daily basis,” Brown says. “It’s always there, and it doesn’t have to be real. There’s this heightened awareness because we’re always anticipating where the next thing is coming from.”

This phenomenon is known as allostatic load, the cumulative biological burden through daily adaptation to physical and emotional stress. It is considered to be a risk factor for cardiovascular disease, obesity, diabetes, depression, cognitive impairment and inflammatory and autoimmune disorders, according to the American Psychological Association.

Know how to prevent and recognize a stroke

Narrowing the gap will require a full-force attack — one that demands science, advocacy and equity, Lloyd-Jones says. “We have to pull out all the stops,” he adds.

In the meantime, there is some good news: About 80 percent of strokes are preventable, simply by adopting a healthier lifestyle. And “it is never too late to start” making those healthier changes, Lloyd-Jones says.

Lower Your Risks

Not all risk factors for stroke can be controlled, but many can. Here’s what you can do to lower your risk for stroke:

Eat more fruits and vegetables.
Reduce salt in your diet.
Increase your physical activity.
Quit smoking.
Lose excess body weight.
Manage stress

Source: American Heart Association

“Anything that you can do — improving your diet, your physical activity, your weight, if you need to stop smoking, get control of your cholesterol, your blood pressure, your blood sugar. Pick one of those things and it will have a huge impact on your health in the coming years,” he says.

In addition to lowering risks, it’s also important to know the signs of stroke, because if you or a loved one suffer one, every second counts. According to the CDC, the most common warning signs of stroke include:

Sudden numbness or weakness in the face, arm or leg, especially on one side of the body.
Sudden confusion, trouble speaking or difficulty understanding speech.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance or lack of coordination.

The longer a stroke goes untreated, the more brain cells die, and the less likely it is that treatments will work. Yet research shows that the vast majority of stroke victims (about 70 percent) don’t receive medical care within the first hour of symptoms.

That was the case with both Horton and Moore, who failed to get immediate treatment. Against the odds, they recovered, though they still struggle with some effects of their strokes, and now they are making sure others avoid what they went through. Horton founded a nonprofit that hosts an annual 5K walk; Moore wrote about his experience in a memoir, “A Stroke of Faith.”

“Too often, people arrive at the hospital later in the process, where it’s harder for us to salvage brain function and brain tissue,” Lloyd-Jones says. “It’s critically important that we have powerful voices out there telling people that [stroke] is something they need to pay attention to.”

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