Study: Black Women of Childbearing Age Are More Likely to Have High Blood Pressure, Pregnancy Risks

Black women of childbearing age were twice as likely to have uncontrolled high blood pressure compared with their White peers, which raised their risk of heart-related complications during pregnancy, according to new findings published in the Journal of the American Heart Association.

Earlier research has found that Black, Hispanic, and Asian women face a higher risk of complications and stroke during childbirth, and Black and Hispanic women who develop pregnancy-induced high blood pressure are at least 6 times more likely to die than White women.

“A better understanding of racial and ethnic differences in hypertension control may help advance health equity in the United States,” the authors wrote in the study.

The new data comes from an analysis of nearly 18 years of data. High blood pressure affects 17.6% of women of childbearing age in the United States and has increased over the past decade, according to 2019 data from the National Center for Health Statistics. If undetected and uncontrolled, high blood pressure can lead to stroke or heart attack, as well as preeclampsia and eclampsia, which are potentially fatal conditions in which blood pressure spikes during pregnancy.

The study examined social factors that influence blood pressure control by race and ethnicity among women in the United States of childbearing age with high blood pressure.

“Although high blood pressure is a treatable, common chronic health condition, it is a leading cause of pregnancy-related deaths and severe disease,” said senior study author Lara C. Kovell, MD, in a press release. “The United States has much higher rates of pregnancy-related deaths than economically similar countries, and Black women are disproportionately affected.”

The investigators reviewed data from the National Health and Nutrition Examination Survey from 2001 through 2018, which included 1293 women of child-bearing age, with an average age of 36 years, who had a diagnosis of hypertension with a high blood pressure above 140/90 mm Hg or a self-reported history of antihypertensive medication use. Approximately 59% of the participants were White women, 23% were Black women, approximately 16% were Hispanic women, and 1.7% were Asian women. Approximately 20% of the participants had never been pregnant.

The study authors defined uncontrolled high blood pressure as a systolic blood pressure of 140 mm Hg or higher and a diastolic blood pressure of 90 mm Hg or higher. Three consecutive blood pressure measurements were taken after 5 minutes of seated rest, with 1 minute in between measures, and the average was calculated. Women also answered questions about their lifestyle, such as diet, exercise, smoking and alcohol intake, access to health care, education, and blood pressure medication use.

Social determinants of health factors examined in the study were based on the American Heart Association’s Scientific Statement on Social Determinants of Risk and Outcomes for Cardiovascular Disease, and included education, income, food security, home ownership, language, and access to health insurance and medical care.

“Food insecurity is important when thinking about high blood pressure since sodium levels are higher in many lower-cost food options such as canned, ultra-processed, and fast foods,” Kovell said in the press release. “Moreover, food insecurity and a lack of access to healthy foods have been shown in other studies to increase the risk of high blood pressure.”

Among the key findings, Black women of childbearing age with high blood pressure were more than twice as likely to have uncontrolled high blood pressure than White women. Among those who were aware of their diagnosis, Black women were 3 times more likely to have uncontrolled blood pressure. The risk factors for high blood pressure persisted among Black women after considering social determinants of health.

Black and Asian women had a higher average blood pressure and were more likely to have uncontrolled high blood pressure than White women, at 38% and 36%, respectively, versus 25%. Food insecurity was also higher among Hispanic and Black women compared with White women, with 1 in 4 Black women and 1 in 3 Hispanic women reporting food insecurity.

Finally, Asian women were more often unaware of their high blood pressure and were more likely to have uncontrolled high blood pressure compared with White women.

“We were surprised by the high prevalence of food insecurity among Black and Hispanic women,” said lead author Claire Meyerovitz, BA, in the press release. “We were not expecting to see such a dramatic inequity in this social determinant of health. While our population of Asian women was small, we were also surprised to find that 26% of Asian women of childbearing age were unaware of their hypertension, which was significantly more than White women at 14%.”

The investigators said more research is needed, including examinations of structural racism and discrimination, to better understand why Black women of childbearing age face challenges in both food insecurity and heart health. The study was limited by the fact that the interplay of race, racism, the US health care system, and social inequity is complex and unique.

“Questions about food insecurity and health care access should be included in the standard screening questions at hospital or clinic visits, especially among pregnant women or women planning to become pregnant,” Kovell said in the press release. “We still have a lot of work to do to understand and reverse the disparities in maternal mortality between White and Black women in the US.”

REFERENCE

Black women of childbearing age more likely to have high blood pressure, raising pregnancy risks. News release. American Heart Association; February 27, 2023. Accessed February 27, 2023. https://newsroom.heart.org/news/black-women-of-childbearing-age-more-likely-to-have-high-blood-pressure-raising-pregnancy-risks?preview=b27a