New observation data indicates that Black women who develop high blood pressure before the age of 35 have a threefold increased risk of experiencing a stroke in midlife. The Black Women’s Health Study, which has been ongoing since the 1990s and has 59,000 participants in the United States, also revealed that those who develop high blood pressure before the age of 45 have twice the risk of experiencing a stroke.
„The truly concerning aspect of this data is the high percentage of young Black women who had high blood pressure relatively early in life and are experiencing strokes,“ said study lead author Hugo J. Aparicio, MD, Associate Professor of Neurology at the Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, as reported by theheart.org | Medscape Cardiology. „This can lead to disability in relatively young women who may be in the prime of their lives, pursuing a career, and caring for their families.“
Aparicio will present the full data at the International Stroke Conference 2024 in Phoenix, Arizona, next week. He explained that while there have been significant advancements in reducing stroke rates among older individuals in recent decades, there is a concerning observation from multiple datasets showing that stroke rates in midlife have plateaued or even increased in recent years.
„There is cause for concern specifically for Black women, as we know that this group overall suffers from higher instances of high blood pressure and strokes,“ Aparicio said. „We were interested in whether the onset of high blood pressure at an earlier age in this group is one of the reasons for the increased risk of stroke in midlife.“
The researchers analyzed data from the Black Women’s Health Study, a prospective study with 59,000 Black women from across the United States. The baseline year for this analysis, which included 46,754 stroke-free participants under 65 years of age (average age 42), was the 1999 questionnaire.
High blood pressure history, defined as physician-diagnosed high blood pressure or the use of antihypertensive medications, and the occurrence of strokes were determined through self-reporting. Previous studies have shown that these self-reported data on the frequency of high blood pressure in this dataset are highly reliable, noted Aparicio.
At the beginning of the study, 10.5% of participants aged 45 to 64 had high blood pressure. During an average follow-up period of 17 years, 3.2% of individuals experienced a stroke.
Black women with high blood pressure before the age of 45 had a higher risk for a midlife stroke (hazard ratio [HR], 2.23; 95% CI, 1.79–2.78), after adjusting for age, neighborhood socioeconomic status, residence in the Stroke Belt, smoking, body mass index, and diabetes, compared to women without a history of high blood pressure.
The risk was also elevated for high blood pressure in midlife (age 45-64) (HR 1.69; 95% CI 1.47 to 1.95) and highest for individuals with high blood pressure between the ages of 24 and 34 (HR 3.15; 95% CI 1.92–5.16).
„Our results show that young Black women with high blood pressure have a much higher risk of stroke than women without high blood pressure, even if they are taking antihypertensive medications,“ Aparicio said. „This underscores how significantly high blood pressure is a risk factor for strokes.“
He concluded that individuals and healthcare providers must recognize that high blood pressure and stroke are not solely issues for older individuals. „These are conditions that must be addressed very early in life. This is even more crucial for Black women, as they are a high-risk group. They need to monitor their blood pressure from an early age—ideally from puberty—catching levels before they become too high,“ Aparicio said.
„We also need to address lifestyle changes, including diet, physical activity, and sleep habits, and consider other cardiovascular risk factors such as cholesterol and body mass index in order to prevent strokes,“ he added. „At the policy level, we need to advocate for, provide, and fund primary prevention measures and enable earlier detection and better treatment.“
The Role of Psychosocial Stress Factors
In her commentary on the study, former American Heart Association president Michelle A. Albert, MD, Professor of Medicine at the University of California, San Francisco, California, emphasized the importance of regular primary care visits to screen for high blood pressure and other cardiovascular risk factors.
She noted that one of the factors that could increase the risk for Black women is their disproportionate experience with psychosocial stress factors and chronic cumulative stress. These factors may include stress related to financial issues, racism and other forms of bias, neighborhood environment, and the need to care for multiple generations of families with limited resources.
„These are some of the things that are not talked about as much, and we need to address the increased risk for many cardiovascular risk factors, including high blood pressure, very early in the lives of Black women and bring this to the forefront of discussions,“ Albert said.
„These stress factors not only impact the onset of high blood pressure, but also the ability to seek care and, once care is sought, maintain the recommended therapies and interventions,“ she added.
The authors reported no relevant disclosures.