By Kiara Doyal, The Seattle Medium
Monique Shields never expected her pregnancy to mark the beginning of a lifelong struggle with high blood pressure. Diagnosed with preeclampsia—a pregnancy-related condition marked by dangerously high blood pressure—Shields delivered her first child safely. But her elevated blood pressure is something that follows her to this day.
“I didn’t know anything about it; I had no idea what preeclampsia was. I couldn’t even pronounce it because I had never heard about it,” Shields said. “I didn’t know anything about high blood pressure except that older people had it, so I had no initial thoughts because I didn’t really know what my condition was at the time.”
Initially unaware of her family’s history with hypertension, Shields later learned that heart disease ran deeper in her lineage than she had realized.
“The most I knew was that my grandmother, who was way older, had several strokes, and I always thought it was a little odd to have multiple strokes. But that was really the extent of it,” she said. “Then, coming out of it after my pregnancy, as the years went by, I definitely found out that we have a family history.”
As she began to understand her condition, Shields found the idea of turning her health around discouraging—but not impossible.
“Having to take the medication, and then just not really having a full grasp of what it means, was discouraging. When I would go to the doctor for another ailment of some kind, I was never happy to go because the doctor would not be focusing on that ailment without bringing up my blood pressure,” Shields said. “So, it would get frustrating from that standpoint, and I think that was part of the motivation for me to turn my health around.”
“I didn’t want to be a detriment to my family. I have a young family, and my mom was diagnosed with heart disease [after pregnancy], so I told myself that I had to take care of my health,” she continued.
For Shields, adjusting to the diagnosis was mentally and emotionally taxing. The thought of lifelong medication, combined with constant reminders during unrelated medical visits, made Shields reluctant to fully engage in her care.
“For so long, I didn’t own a blood pressure cuff. If my pills ran out, then they just ran out, and I would probably just get a refill if I already had another appointment,” said Shields. “I wasn’t a pill taker. I was in my early 30s, a young mom, so it was very difficult adjusting to taking medication every day and checking my blood pressure regularly.”
Dr. Naeemah Munir, a physician at Providence Swedish, said she didn’t learn the importance of knowing one’s family medical history until after completing medical school.
“In particular, for patients with preeclampsia, I believe it’s extremely important to know if people in your family or close relatives had preeclampsia, because that puts you at risk for having preeclampsia as well. One of the risk factors is having a first-degree relative who had preeclampsia,” said Munir. “My mother actually had preeclampsia with me, but that was something that I found out later in life. If I were to have children, then that is something that I would need to tell my provider, because there are things that we do when we know someone is at potential risk.”
According to the American Heart Association, hypertension is a leading cause of heart disease, stroke, and kidney disease. Often described as the “silent killer” because it may have no symptoms, hypertension disproportionately affects Black communities. In 2018, Black men had a death rate of 206.6 per 100,000 people, while Black women had a rate of 132.7 per 100,000 — nearly double the mortality rate of White people.
“I hate saying this, but it is a silent killer because you don’t know until it is too late—unless you are really engaged in care and checkups,” said Munir. “Over a period of time, I want the life expectancy of Black and brown people to be similar, if not equal to others, and so when I see someone with high blood pressure, I immediately want to help them.”
Munir said that there are multiple factors that help contribute to these disparities.
“I think that there are some structural things that are going on, like racism and discrimination, as a big one that can be having impacts on the outcome of hypertension and cardiovascular disease. That could be just the stressors of living in the U.S., and that chronic stress has been linked with high blood pressure,” said Munir. “But then there’s also the stressors when interacting with the medical field. Black physicians are underrepresented in medicine, and there are a lot of studies that show that there is a difference within the patient rapport and dynamics. I just feel that patients are not being heard and appreciated.”
Shields admitted that, between her job and life as a new mom, she struggled to prioritize her own care. That changed after the birth of her second child.
“I was induced [with my first child] at 6 months,” said Shields. “I was working full time with a premature baby, so I really didn’t take care of myself or take my medications as I should. I then had another child 5 years later, and I was like I am probably one foot in the stroke door, just because I was taking my medication intermittently and not doing what I needed to do.”
“[After the birth of my second child], I would intentionally get off the bus for work in Downtown Seattle a mile before my stop and walk into work, and then I would use my lunch breaks to walk, and that ended up becoming a routine, where I was pretty much doing that for about two years straight,” added Shields.
Munir says that while making lifestyle changes can be difficult, even that may seem like very small changes can make a huge difference.
“I like to say that everything within moderation is the best way to manage high blood pressure. Doing any sort of little changes can be sustainable,” said Munir. “You don’t need to feel like you have to go to hot yoga or get a CrossFit membership. Any change, little or small, helps. It can be just walking for 30 to 45 minutes.”
Above all, Shields says that having hypertension or heart disease is really a wakeup call to make lifestyle changes that will help you improve your overall health.
“That is what really took a lot for me to get my head around, that it was more than just taking the pill,” says Shields. “I needed to change my lifestyle. Sometimes when I hear that people have really high blood pressure and are sent to the emergency room, it is because there is more to it. It is our diet, our exercise, our drinking, our smoking, all of that. And that is what I had to learn, that it is not just taking this miracle pill and being better. It encompasses everything and more.”
“For those who are unknown, it is really important to regularly check your blood pressure, especially if you are a woman of color, because we are number one at risk for high blood pressure and heart disease,” added Shields.
