Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (S.T.H.).
Institute for Excellence in Health Equity, Grossman School of Medicine, New York University, New York, NY (V.F.).
Hypertension. 2024 Nov;81(11):2218-2227. doi: 10.1161/HYPERTENSIONAHA.124.20533. Epub 2024 Sep 4.
The purpose of this article is to summarize disparities in blood pressure (BP) by race in the United States, discuss evidence-based strategies to increase equity in BP, review recent American Heart Association BP equity initiatives, and highlight missed opportunities for achieving equity in hypertension. Over 122 million American adults have hypertension, with the highest prevalence among Black Americans. Racial disparities in hypertension and BP control in the United States are estimated to be the single largest contributor to the excess risk for cardiovascular disease among Black versus White adults. Worsening disparities in cardiovascular disease and life expectancy during the COVID-19 pandemic warrant an evaluation of the strategies and opportunities to increase equity in BP in the United States. Racial disparities in hypertension are largely driven by systemic inequities that limit access to quality education, economic opportunities, neighborhoods, and health care. To address these root causes, recent studies have evaluated evidence-based strategies, including community health workers, digital health interventions, team-based care, and mobile health care to enhance access to health education, screenings, and BP care in Black communities. In 2021, the American Heart Association made a $100 million pledge and 10 commitments to support health equity. This commitment included implementing multifaceted interventions with a focus on hypertension as a seminal risk factor contributing to disparities in cardiovascular disease mortality and morbidity. The American Heart Association is one organizational example of advocacy for equity in BP. Achieving equity nationwide will require sustained collaboration among individual stakeholders and public, private, and community organizations to address barriers across multiple socioecological levels.
本文旨在总结美国不同种族之间血压(BP)差异的情况,讨论增加 BP 公平性的循证策略,回顾最近美国心脏协会(AHA)在 BP 公平性方面的倡议,并强调在实现高血压公平性方面存在的错失机会。超过 1.22 亿美国成年人患有高血压,其中黑人的患病率最高。美国高血压和 BP 控制方面的种族差异被估计是导致黑人和白人成年人心血管疾病风险过高的最大单一因素。在 COVID-19 大流行期间,心血管疾病和预期寿命的差距不断扩大,这需要评估在美国增加 BP 公平性的策略和机会。高血压方面的种族差异主要是由限制获得优质教育、经济机会、社区和医疗保健机会的系统性不平等造成的。为了解决这些根本原因,最近的研究评估了循证策略,包括社区卫生工作者、数字健康干预、团队护理和移动医疗保健,以增强黑人社区获得健康教育、筛查和 BP 护理的机会。2021 年,美国心脏协会承诺投入 1 亿美元,并做出 10 项承诺,以支持健康公平。这一承诺包括实施多方面的干预措施,重点关注高血压作为导致心血管疾病死亡率和发病率差异的主要风险因素。美国心脏协会是倡导 BP 公平性的一个组织范例。要实现全国范围内的公平性,需要个别利益相关者以及公共、私营和社区组织之间的持续合作,以解决多个社会生态层面的障碍。