A cardiologist explains some of the factors that put African Americans at risk and how health care providers can help.

Published: February 22, 2019 | Updated: October 19, 2023

Heart disease kills more Americans than any other disease, and according to the American Heart Association, African Americans may face a higher risk for heart disease compared with other groups. Kelly C. McCants, M.D., cardiologist and medical director of Norton Heart & Vascular Institute Advanced Heart Failure Program, said uncontrolled high blood pressure is the leading cause of heart disease for all people. African Americans have the highest rate of high blood pressure compared with other groups.

The role of high blood pressure in heart disease and heart failure

“There are many theories on why African Americans are plagued with heart disease,” Dr. McCants said. “The most likely answer is underlying high blood pressure. When we examine the diet that African Americans have historically consumed, it tends to be higher in salt. A diet high in salt can contribute to high blood pressure, and high blood pressure can then lead to heart disease and heart failure.”

READ MORE: Pastor F. Bruce Williams’ Heart Failure Recovery Story

Other factors that contribute to high blood pressure in African Americans

According to Dr. McCants, some other considerations for African Americans lead to increased risk:

• African Americans may have subclinical hypertension, which means their blood pressure may be borderline high in their health care provider’s office, but then dangerously high when they go home.
• High blood pressure is occurring in younger patients, but younger patients may be reluctant to take medication for blood pressure or make lifestyle changes, especially since they don’t feel bad.
• High blood pressure may be recognized or diagnosed later in African Americans: “By the time an African-American patient walks into a provider’s office and is diagnosed with high blood pressure, the disease is often further along,” Dr. McCants said. “The further along a patient is in the disease process, the less likely we will be able to halt the disease, and treatments may no longer be effective.”

How can health care providers help African Americans reduce their risks and improve their outcomes?

Dr. McCants recommends that health care providers practice what he calls “culturally sensitive medicine.”

“African Americans may have a different disease trajectory — the disease may progress faster — and it’s OK for health care providers to acknowledge that because there is significant data to support this,” Dr. McCants said.

Historically, African-American participation in research studies has been low, so Dr. McCants recommends enrolling more African Americans in research. He also points out that results from studies which did not have significant African-American participation may not be applicable to African Americans.

What can the African-American community do?

“We need to make sure African Americans are screened for high blood pressure earlier, and this can be done by engaging African Americans in churches, barber shops and other places where the community gathers socially,” Dr. McCants said. “We need to encourage African Americans to work with their health care providers to get screened.”

According to Dr. McCants, more education is needed so people recognize the seriousness of high blood pressure.

“High blood pressure is the silent killer,” Dr. McCants said. “People associate their health with how they feel, but high blood pressure doesn’t make you feel bad. Instead, you may be out in your life feeling great while uncontrolled high blood pressure is making you very sick.”

African Americans and heart failure treatment

According to Dr. McCants, in addition to the work to help reduce heart disease and heart failure risks in the African-American community, there is good news for African Americans with heart failure.

“Nonischemic heart failure” is heart failure that is not associated with blockages. Instead, high blood pressure is often the cause.

“Our heart recovery program works with patients who have heart failure due to high blood pressure, which is what we see a lot in African Americans,” Dr. McCants said. “In some cases we can reverse or recover the heart after heart failure. This means we can help make the heart normal again.”

Heart failure patients can be referred to the heart recovery program by their primary care provider or after admission to the hospital for heart failure. Norton Heart & Vascular Institute’s Advanced Heart Failure Program also can diagnose heart failure in patients who are experiencing symptoms such as lower-extremity swelling, shortness of breath and fatigue.