High Blood Pressure

What it is

High blood pressure is the force of blood pushing against your artery walls staying too high over time. It is diagnosed on consistent systolic readings of 130 mm Hg or higher, or diastolic readings of 80 mm Hg or higher [1].

Why this guide is written for Black patients

The National Heart, Lung, and Blood Institute states plainly that high blood pressure is more common in Black adults than in white, Hispanic or Asian adults, that Black people tend to have higher average blood pressure numbers, and that they tend to develop high blood pressure earlier in life [2].

Two further points from the same page change how an appointment should go. Some blood pressure medicines may not work as well for Black people [2]. And during pregnancy, Black women are more likely than white women to develop preeclampsia [2].

Downstream, in 2022 Black Americans were 35 percent more likely than the US population overall to die from major diseases of the heart and blood vessels [3].

What to ask a clinician

• What are my actual numbers today, and which stage is that? Stage 1 is 130 to 139 systolic or 80 to 89 diastolic. Stage 2 is 140 or higher, or 90 or higher [1].
• What number are we aiming for, and by when?
• If this medicine does not move the number in a month, what is the next one, and why that one?
• Should I be checking at home, and can you watch me take a reading so I know I am doing it right?
• Are any of my other medicines pushing the number up?

What good care looks like

Good care is measured, not guessed. It means readings taken more than once, because a diagnosis rests on consistent numbers rather than one bad afternoon [1]. It means home readings brought to the visit, ideally twice a day for a week, sitting, on the same arm, written down.

It also means a clinician who changes the plan when the number does not move. Because some medicines work less well in Black patients [2], a reading that stays high after a fair trial is a reason to change or add a medicine, not a reason to be told to try harder. Ask for that conversation by name.

Controlling blood pressure can help prevent or delay chronic kidney disease, heart attack, heart failure, stroke and possibly vascular dementia [1]. Those five are the reason anyone takes a daily tablet for a condition they cannot feel.

When it is urgent

Symptoms from high blood pressure do not usually appear until it has caused a serious problem [1]. So the urgent signs are the signs of the problems it causes: chest pain or pressure, sudden weakness or numbness on one side of the body, trouble speaking or seeing, a sudden severe headache, or breathlessness that arrives at rest. Any of those is 911, immediately.

If you are pregnant or recently gave birth, a headache that will not clear, blurred vision, swelling in the face or hands, or pain under the right ribs needs to be seen the same day, because of the link with preeclampsia [2].

What to do next

Start with a primary care doctor. See Black primary care physicians if you do not have one, and book the appointment before you feel anything, because you will not.

If your number stays above target on two or more medicines, ask for a referral to a Black cardiologist and bring your home readings with you. Take the pill bottles rather than a list from memory.