By Aaron Allen, The Seattle Medium
Hypertension, or high blood pressure, is often called the “silent killer” because it frequently develops without noticeable symptoms while quietly damaging blood vessels and increasing the risk of heart disease, stroke, heart failure, and other serious cardiovascular conditions.
In the United States, this burden falls disproportionately on Black communities. Roughly 55% of Black adults live with hypertension, often developing the condition earlier in life and experiencing more severe complications than other demographic groups.
“Most of us in the medical community are aware that there’s been a lot of research that has shown that African American adults have a higher risk of cardiovascular disease, including a higher risk of heart attacks and strokes than other racial and ethnic groups,” said Dr. Vid Yogeswaran, a cardiologist at the University of Washington. “I think it’s really important that African American adults are aware of that risk.”
Nearly 60% of Black adults age 20 and older in the U.S. have some form of cardiovascular disease, including coronary heart disease, heart failure, stroke, and hypertension. That compares with about 49% of all U.S. adults.
Among all adults in the U.S., stroke prevalence is highest among Black women at 5.4% and Black men at 4.8%, compared with 2.9% of all women and 3.6% of all men.
Black adults also have some of the highest rates of hypertension in the world, with 58.4% of Black women and 57.5% of Black men living with high blood pressure. Black adults account for more than 50% of heart failure hospitalization burdens among U.S. adults younger than 50.
The burden is visible locally as well.
“Looking at data in King County in particular, hypertension is about 25% prevalence across the board, so about 25% of all adults in King County have hypertension,” said Dr. Paul Park, an internal medicine primary care physician and medical director for the Community Health Services Division of Public Health — Seattle & King County. “Now among the Black community, the Black adults in King County, it’s significantly higher. It’s about 32% of all adults in the Black community in King County have hypertension.”
Park said the disparity extends beyond prevalence.
“This disparity that we’ve been talking about where hypertension, high blood pressure, cardiovascular disease — it’s not only more prevalent, it’s not only more common among the Black community, but studies have actually shown that the conditions themselves are more severe,” said Park.
Health experts say understanding the crisis requires looking beyond individual choices and examining the broader conditions that shape health outcomes.
Those factors include access to health care, insurance coverage, transportation, housing stability, neighborhood conditions, healthy food access, environmental stressors, and historical discrimination within health systems.
“These social determinants of health are things such as lack of health insurance, limited access to healthy foods, it could be housing insecurity,” said Park. “It could also be the historical distrust and discrimination against the Black community by health systems in the past and sometimes currently.”
Park said those conditions are rooted in deeper inequities.
“What we do want to emphasize and focus on are the social determinants of health and understanding that the Black community, through historical injustices, are in difficult situations where they aren’t given a just opportunity to access health insurance, to access transportation, to have a higher socioeconomic status,” said Park.
Environmental factors can also contribute to cardiovascular risk. Higher exposure to neighborhood instability, noise, air pollution, and limited access to safe parks or green spaces can increase stress and reduce opportunities for physical activity.
Economic conditions further compound the issue. In many communities, fresh and healthy foods may be difficult to find or afford, leaving residents more dependent on processed foods that are often high in sodium. Chronic stress, lower physical activity, smoking, diabetes, excessive weight, and family history can also increase risk.
Researchers have also identified biological factors that may contribute to elevated risk. Certain traits common among people of African descent may increase salt sensitivity, potentially contributing to fluid retention and higher blood pressure. Some hypertension medications may also vary in effectiveness, making individualized treatment approaches important.
Because hypertension often develops without symptoms, regular screening remains one of the most effective prevention tools.
During routine visits, health care providers monitor blood pressure alongside other indicators linked to cardiovascular risk, including weight, body mass index, cholesterol levels, and blood glucose levels used to screen for diabetes.
Risk factors commonly associated with hypertension include older age, excessive weight, diabetes, smoking, physical inactivity, and family history.
“I just want to emphasize that I think it’s really important that everybody see their primary care doctor at least once a year,” said Yogeswaran. “And if you do feel like you’re at risk for heart disease or there are questions that your primary care physician cannot answer about your heart risk, then it can be helpful to see a preventive cardiologist to talk about your risk. But I think you should always start at your primary care doctor, talk about your risk.”
Park agreed that annual checkups are one of the most important steps people can take.
“I personally think the number one most important thing to do is to make sure that people are seeing their primary care doctor every year,” said Park. “To make sure that those general risk factors are being identified and if they do have them being treated.”
While systemic inequities require broader policy and institutional changes, health experts say regular screenings, consistent primary care, and early treatment can help reduce the risk of heart attack, stroke, heart failure, and other complications.
Access barriers, including transportation challenges and restrictive work schedules, can make traditional doctor appointments difficult. To help bridge those gaps, mobile health services and neighborhood-based care models can bring screenings, primary care, and chronic disease management directly into communities.
Health experts also say people do not have to navigate their health journey alone. Sharing health goals with family, joining community support programs, and staying connected to local health resources can provide encouragement and accountability.
Because hypertension often develops silently, early detection remains one of the most powerful tools for prevention.
