Hypertension

4 keys to address high BP, stroke among your black patients

John Singleton made Academy Award history when he became the first African American and youngest person nominated for best director at the age of 24. Tragically, he also died this spring at an early age from stroke, which is the fifth leading cause of death in the U.S.  

The risk of having a stroke is nearly twice as high for blacks as for whites. African Americans also have the highest rate of death due to stroke, according to the Centers for Disease Control and Prevention. The leading risk factor for stroke is high blood pressure. African Americans have among the highest prevalence of high blood pressure in the world.  

The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help manage their patients’ high BP. These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and American Heart Association.  

Knowing the increased risk that many black patients face, here is how physicians can improve prescribing patterns and lifestyle changes to prevent high blood pressure and stroke among African American patients.  

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Identify lifestyle challenges 

It can often be difficult for all patients to make healthy lifestyle changes. African American patients may have it even harder. For example, if a patient lives in a food desert where access to affordable fresh fruits and vegetables is limited, eating a DASH-type diet becomes more difficult. In these areas, fast food high in saturated fat and sodium are often more readily available.  

Additionally, adhering to the recommendation of 150 minutes of aerobic activity a week can be harder because of neighborhoods where safe, walkable streets are less common. To overcome lifestyle challenges, physicians should offer solutions based on where patients live and the resources available to them, such as alternatives to various food options. 

Boost medication adherence  

Physicians play an important role in helping patients adhere to taking their medications as directed. When doctors prescribe a medication, they might not always have or take the time to explain how it works, possible side effects or the importance of taking the medication as prescribed. And if the patient is having side effects like leg swelling or fatigue they might just stop taking it without letting their physician know.  

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It is best to sit down with the patient, explain what to expect, and let them know they are accessible if any questions come up. This may initiate some level of activation that increases the likelihood that patients will take their medication as directed. Health care team members should spend time with patients to help increase their understanding of the disease process and potential ramifications of uncontrolled high BP. 

Pay attention to health literacy 

Physicians are comfortable using medical terms during a visit, and many patients may nod approvingly. However, they often do not understand exactly what the doctors are saying, which can create a barrier to communication, and potentially impact their health. Technical language might be needed to document in the electronic health record, but it is important to talk to patients in plain, direct and easy-to-understand language.  

The few extra minutes it might take to do this or have a member of the clinical team do this could have significant impact on the patient’s care. It will also help patients better understand their condition and next steps.  

Include family members 

Having a family member present will go a long way with increasing medication adherence, understanding cardiovascular risk and the need for lifestyle modification. A family member can help patients better retain what the physician has been saying. This person then becomes the patient’s partner in care and is a great benefit for both the patient and physician—removing a barrier to care.  

Family members can also be a source of inspiration for making lifestyle changes, such as reduction of sodium in prepared foods and avoiding process foods. They can also become a partner in an exercise program and ensure patients take their medications or get refills when needed. This can improve adherence to a treatment plan and ultimately, a patient’s health.