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African-Americans and High Blood Pressure

Posted Aug 24 2008 1:49pm
ANNONCER: One of the most serious health issues in the African-American community is hypertension. Dr. Reginald Robinson a Washington, DC-based cardiologist explains some of the basics of this disease.

REGINALD L. ROBINSON, MD: Hypertension is a disease process; most people will know it by blood pressure. And blood pressure would be a measure of how the heart contracts. The top number, we call that systolic blood pressure. When the heart squeezes, that's the top reading. The bottom reading is when the heart relaxes, called the diastolic blood pressure.

ANNOUNCER: Hypertension is indicated when the blood pressure reading is a number equal or exceeding 140 over 90. Often those who are developing hypertension are unaware of it.

REGINALD L. ROBINSON, MD: The most common symptom is actually nothing. So you don't want to actually have symptoms when you have hypertension. So when you're having symptoms from hypertension, that's when you're having your first stroke or your first symptom of congestive heart failure. Some people, maybe a little more fatigued, headaches, nosebleed, or what we call epistaxis.

ANNOUNCER: The effects of hypertension on the African-American community are extensive.

REGINALD L. ROBINSON, MD: When you look at our population as a whole, we probably have the leading cause of kidney failure from hypertension. When we have hypertension, you're probably four times more likely to have kidney failure or require dialysis. Probably two to four times more likely to have a stroke from hypertension, and hypertension is the leading cause of congestive heart failure in the African-American population.

ANNOUNCER: There are several theories why African-Americans seem to be more susceptible to hypertension.

REGINALD L. ROBINSON, MD: Some think that it's because we're more salt-sensitive, and when we require blood pressure medicines, we usually require two or three medicines to control our blood pressure. There's also the issue of healthcare disparity where a lot of our folks aren't getting the proper treatment or not getting to the doctor to get hypertension control until it's too late, when they're having the symptoms of congestive heart failure or their first heart attack or they're on a dialysis machine.

ANNOUNCER: The risk factors for hypertension range from genetic factors to lifestyle issues like obesity, lack of sufficient exercise, diet, and excessive salt intake. But there is also thought to be a cultural component.

REGINALD L. ROBINSON, MD: We tend to be a little more salt-sensitive; it's something that we've grown from. We had to store things, and what do you do to store things? You put it in salt and that's something that's still ingrained in our and that's something we need to really change.

ANNOUNCER: For those with hypertension, serious complications can arise.

REGINALD L. ROBINSON, MD: Stroke, probably two to three times or two to four times higher risk of stroke from hypertension. Congestive heart failure; again, the leading cause of congestive heart failure in our community is hypertension. Kidney failure: Everyone knows someone that's on dialysis or requiring to sit in the room for three hours at a time, three days a week. And if you go into any dialysis center, especially in the urban areas, you'll see young African-American men and older African-American women. African-American men tend to get it aggressively.

ANNOUNCER: While there are treatment options available for hypertension, sometimes myths within the African-American community can stand in the way.

REGINALD L. ROBINSON, MD: The biggest myth is, I would say, the fear of the medical community and that they are going to be the guinea pigs. I mean, everyone knows about the Tuskegee syphilis experiments. Some of the myths in the medical community, which they're still teaching in some medical schools, are that African-Americans don't respond as well to other medications that Caucasian-Americans may respond to, and that's also a myth. It's just being more aggressive with treating; we may need more, but we also respond to those same medications.

ANNOUNCER: For those who do seek treatment there are some standard tests that are initially done.

REGINALD L. ROBINSON, MD: When they come in, everyone gets a blood pressure check. That's the simplest thing to do. You should get a blood pressure check. Initially, we'll do it in both arms to make sure they're equal. Get an EKG or electrocardiogram. That looks at the electrical system of the heart; it's just like taking a photo of your heart. It's a recording of what your heart's doing at that one second, when the EKG is done.

Some people with high blood pressure, we like to do what's called an echocardiogram or an ultrasound or sonogram; most people know it by a sonogram. And that actually looks at the structure of the heart. If you come in with other symptoms, say, chest pain, chest pressure, there are different types of stress tests that we actually do.

ANNOUNCER: Once a patient is diagnosed with hypertension, there are several major classes of drugs available for treatment.

REGINALD L. ROBINSON, MD: The simplest one, people call it the water pill or the fluid pill. Its scientific name: a diuretic. Another class is called an ACE inhibitor. Those are some of the drugs that end in "-il," enalapril, captopril or Monopril. Those are beneficial in people with diabetes to help protect their kidneys.

Another class is called a beta-blocker. Beta-blocker, they block adrenaline. Everyone knows adrenaline. So if someone stops in front of you in a car, your heart rate increases: That's adrenaline. The beta blockers try to help blunt that effect. There's another class called a calcium-channel blocker. They work a different way. Some of the names that you might hear are Norvasc, Procardia, Cardizem, diltiazem, verapamil.

ANNOUNCER: Aside from medications, some treatments involve daily activities patients can do for themselves.

REGINALD L. ROBINSON, MD: I always like the term "TLC" first, total lifestyle change. I don't have to tell people that they don't need to smoke. I don't need to tell people they don't need to drink excessively or I don't need to tell people that they need a more active lifestyle. So those are things that most people know; it's just the reinforcement of it that they can do before you even come to me.

Say if you came in with what we call stage I hypertension, that's a blood pressure the top number 140 to 159 over 90 to 99. Then, you can probably get away with total lifestyle change first or considering a drug if you have another comorbid condition, meaning you have diabetes with it or you're a smoker with it or you've had a stroke with it. But everyone's going to get that TLC upfront and lifelong, actually, because you'll end up adding more drugs if they're still doing their same habits, if they're still smoking, if they're still overweight, if they're still throwing the salt on. So TLC first, then adding drugs on top of that, if needed.

ANNOUNCER: For those who have hypertension, and those who don't, getting a regular blood pressure test is important. How often that should be done varies.

REGINALD L. ROBINSON, MD: If it's in the normal range and if you're just going to get your routine evaluation and you don't have hypertension per se, then on a yearly basis. But, if you have hypertension, any time you make a change in the blood pressure medicine, you may need to come back in a month. It varies on how high the blood pressure is, what your goal is, what other comorbid conditions, meaning what other medical issues you have, especially diabetes, prior stroke, congestive heart failure or prior heart attack.

ANNOUNCER: Since hypertension is such a serious issue some medical professionals are now trying to reach directly into the African-American community to get their message of routine testing and lifestyle change across.

REGINALD L. ROBINSON, MD: One approach I do is actually go out to the community. Give back, go back and talk to the community organizations, go into the communities to actually talk to the people that need it most. I can't emphasize enough the total lifestyle change, and that's usually the case that we might be our own worst enemy, when it comes to trying to prevent or to maintain our health.

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