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.”