Hypertension Before 35 Tied to Triple Stroke Risk in Midlife

New observational data suggests that Black women who develop high blood pressure before the age of 35 face a threefold increased risk of having a midlife stroke. The Black Women's Health Study, which has been tracking 59,000 participants in the United States since the 1990s, also reveals that those who develop hypertension before the age of 45 have twice the risk of suffering a stroke.

Lead author Hugo J. Aparicio, MD, an associate professor of neurology at Boston University Chobanian & Avedisian School of Medicine, expresses concern about the high proportion of young Black women experiencing strokes relatively early in life. Aparicio will present the complete data at the upcoming International Stroke Conference 2024 in Phoenix, Arizona.

While there has been progress in reducing stroke rates in older individuals, recent observations from multiple datasets indicate that stroke rates in midlife have been plateauing or increasing. Aparicio notes a particular concern for Black women, given their higher rates of raised blood pressure and stroke.

The study analyzes data from the Black Women's Health Study, a prospective study of 59,000 Black women across the United States. The baseline year for the analysis, which includes 46,754 stroke-free participants under the age of 65 (mean age 42 years), is the 1999 questionnaire.

The study finds that Black women with hypertension before age 45 have a higher risk of midlife stroke, even after adjusting for various factors. The risk is also elevated with hypertension at midlife ages 45-64 years and is highest among those with hypertension at ages 24-34 years.

Aparicio emphasizes the need for early attention to hypertension and stroke, urging both individuals and doctors to address these issues early in life. Lifestyle changes, including diet, physical activity, and addressing other cardiovascular risk factors, are crucial for prevention. Aparicio concludes that policymakers should advocate, provide, and fund primary prevention measures, enabling earlier screening and better treatment.

Commenting on the study, Michelle A. Albert, MD, the immediate past president of the American Heart Association, highlights the importance of regular primary care appointments to screen for high blood pressure and other cardiovascular risk factors. She also emphasizes the role of psychosocial stressors, such as financial issues, racism, and bias, in increasing the risk for Black women. Albert calls for increased awareness of these stressors and their impact on cardiovascular risk factors, early intervention, and sustained therapies.