In the U.S., the death rate for African Americans with heart disease is declining. However, more than 100,000 African Americans continue to die each year from cardiovascular disease and retain a significantly higher death rate than any other racial group. A January 2022 report from the Office of Minority Health noted that approximately 57% of African Americans have hypertension, with 60% of African American women more likely to be diagnosed with the disease. It is interesting to note that cardiovascular disease risk factors tend to appear earlier in life for African Americans, resulting in a much earlier onset of cardiovascular disease. In a study of coronary artery disease risk in young adults, 96% (n = 26) of the cases of heart failure were in African Americans under the age of 50. A 2014 study published in the American Journal of the Medical Sciences found that on average, a 45-year-old African American man living in the U.S. Southeast has the same risk of having a stroke as a 55-year-old Caucasian man living in the same region or a 65-year-old Caucasian man living in the Midwest. While there are apparent disparities among the prevalence of heart disease in African Americans and other racial groups, physical activity (PA) appears to be a powerful weapon against the onset of high blood pressure.

The Jackson Heart Study tracked PA for more than 1,300 African Americans to examine the relationship between PA and the onset of hypertension. At baseline, 61% of the study participants were physically active, with 24% meeting the current PA recommendations. Researchers found that physically active participants had a 16% lower risk of developing hypertension compared to inactive adults, and those who met the PA recommendations had a 24% lower risk of developing hypertension. In addition, researchers found that the type of PA mattered, and study participants engaged in sport/exercise-related activities had a lower risk of developing hypertension. With only about 20% of African Americans currently meeting the guidelines pre-COVID-19, how can health professionals encourage young African Americans to adopt preventive lifestyles? They can begin by understanding the historical, sociocultural and individual factors that influence African Americans in their care. Specific tasks can include:

• Actively listening to clients in order to build relationships;
• Recognizing and understanding personal biases and how clients may perceive them;
• Educating oneself about the local community and African American culture within that community;
• Asking the client relevant questions to learn more; and
• Providing feedback, data, and resources that the client can identify with instead of utilizing generalized and Eurocentric resources. 

A 2021 study by Lemacks et al. explores a practical example of the aforementioned tasks. The researchers explored the perceptions of weight management among young to middle-aged African American adults. Among their findings was that when participants did not engage in the program because of perceived lack of time, researchers discovered it was more due to physical or mental fatigue. Acknowledging physical or mental fatigue is an important finding because it allows the client to feel heard and the professional to provide resources to address fatigue versus time barriers. The more the client feels heard, the more likely they trust their health professional and implement lifestyle interventions that promote improved health.

It is important to note that individual behavior changes in young and middle-aged African Americans will not dramatically change the national statistics. There needs to be an intentional and concerted effort to provide a public health solution. The American Heart Association News suggests those changes can begin to address the inequities that link structural racism and hypertension to the health of African Americans. “Asking people to improve their diet when they don’t have access to healthy foods, to exercise when they don’t have access to safe or affordable spaces, to take blood pressure medications when they can’t afford them — while also failing to ensure access to quality universal health care — will never succeed in eliminating health inequities,” reports the author. Now is our chance to help young African Americans reduce or eliminate their risk for hypertension by encouraging them to be proactive in seeking care from providers who understand them and adopt preventive lifestyle behaviors.

Related links: 
Blog | Exercise, Type 2 Diabetes and Communities of Color
Handout | Women and Heart Disease
Blog | Mythbusting: Genetics and Heart Disease

Alicia T. Bryan, Ph.D., FACSM, serves as the chair of the Strategic Health Initiative: Women, Sport & Physical Activity of the American College of Sports Medicine. She is a tenured associate professor and interim associate provost of faculty affairs and academic innovation at Columbus State University. She also is an ACE Certified Medical Exercise Specialist and serves as the CEO of Evolutions, Inc. in Phenix City, AL.