Did you know that Booker T. Washington died from complications of uncontrolled high blood pressure?
FRONT PAGE OF THE NEW YORK TIMES, MONDAY, NOVEMBER 15, 1915: DR. B.T. WASHINGTON, NEGRO LEADER, DEAD
“Washington’s death…….was the focus of the 2006 Historical Clinicopathological Conference (CPC) sponsored by the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System in Baltimore……a thorough review of his medical record obtained from the Rockefeller Hospital in New York City by CPC organizers, shows a different diagnosis when examined by modern day standards. “When he was admitted to the hospital, Mr. Washington most certainly presented with malignant hypertension which resulted in kidney failure,” says Jackson T. Wright, Jr., M.D., Ph.D., a professor of medicine at Case Western Reserve University in Cleveland, Ohio. “If his physicians had been able to lower his blood pressure, they most likely would have saved both his kidneys and his life.” According to Dr. Wright, there were no effective therapies for high blood pressure in 1915 and the five-year survival rate for malignant hypertension was less than one percent. “The importance of treating elevated blood pressure was not yet well recognized and would not be generally accepted by the medical community until the latter half of the 20th century,” he says. “Although blood pressure measurements were routinely performed in 1915 and elevated blood pressure was often seen in patients with heart disease, stroke and renal disease, many clinicians still did not appreciate the role that hypertension played in causing those conditions. When hypertension was treated, the interventions generally consisted of warm salt baths, rest, potassium tablets, nitrates and barbiturates.”1
For Black women, the risk of heart disease is especially great. Heart disease is more prevalent among Blackwomen than white women—as are some of the factors that increase the risk of developing heart disease. Women in general can lower their heart disease risk by as much as 82% by leading a healthier lifestyle.
WHAT IS HEART DISEASE?
Coronary heart disease (or coronary artery disease-CAD) is the most common form of heart disease. Often referred to simply as “heart disease,” it is a disorder of the blood vessels of the heart that can lead to a heart attack. If you have coronary heart disease, it is a lifelong condition and will steadily worsen unless you make changes in your daily habits.
Risk Factors for Heart Disease
Lifestyle affects many of the “risk factors” for heart disease. Risk factors are conditions or habits that increase the chances of developing a disease or having it worsen. For heart disease, there are two types—those you can’t change and those you can control. The ones you can’t change are a family history of early heart disease and age.
There are other factors that affect heart health that are difficult to change, but affect Black women significantly including factors related to systemic racism that leads to exposure to chronic life and work stressors, decreased access to grocery stores and transportation and education, income, housing and access to healthcare inequities.
Here’s a quick review of risk factors that you can take action on now:
Smoking
About 13% Black women smoke2. Quit, and just one year later, your heart disease risk will drop by more than half. There’s no easy way to quit but making a smoking cessation plan helps. You also can try an organized program or a medication—ask your doctor if either is right for you.
High Blood Pressure
Also called hypertension, high blood pressure increases your risk of premature death, heart disease, stroke, and congestive heart failure and is the second leading cause of kidney failure behind diabetes. Even levels slightly above normal— called “prehypertension”—increase your heart disease risk. Black women develop high blood pressure earlier in life and have higher average blood pressures compared with white women. In the U.S., nearly 58% of Black women have high blood pressure3. Hypertension also increases the risk of stroke and congestive heart failure—and Black women have high rates of both. Fortunately for many, hypertension is a preventable and treatable disease.
Other than having a genetic predisposition, a major cause of hypertension is the food that we eat. Foods containing salt and too many calories (also a major cause of obesity, diabetes, cancer, high cholesterol, heart disease and stroke) are the major cause of hypertension. Diets that are high in fast food are inherently high in sodium and are bad for blood pressure as well. You can lower elevated blood pressure by following a heart healthy eating plan, including limiting your intake of salt and other forms of sodium (processed and pre-prepared foods) , by getting regular physical activity, maintaining a healthy weight, and limiting the intake of alcoholic beverages. If you already have high blood pressure, you also may need to take medication.
Studies have shown that eating low salt foods, lots of fruits and vegetables and no more than one meat dish per day can lower blood pressure as much as any single blood pressure medication. For those who have not yet developed hypertension, this way of eating can prevent or dramatically slow the development of hypertension. In those who already have hypertension, it can be controlled and the complications of hypertension that can devastate the body can be prevented. The DASH (Dietary Approaches to Stop Hypertension) Eating Plan is a flexible and balanced eating plan that helps create a heart-healthy eating style for life. (https://www.nhlbi..nih.gov/education/dash-eating-plan)
Multiple studies now show that nearly every patient with hypertension can have their blood pressure controlled to the recommended goal of less than 130/80 (optomal blood pressure is less than 120/80), yet less than 1 in 3 are at that goal. In those with higher blood pressure, it is because these patients are either not following the recommended eating habits consistently, not taking their medication or/not prescribed enough of the correct medications by their physician. Many patients will require two and usually three medications to control their blood pressure.
Each time you are seen at a medical visit, you should ask your physician for your blood pressure reading. If the top number (systolic blood pressure (SBP) is higher than 130 or the bottom number (diastolic blood pressure (DBP) is greater than 80, you should insist that a plan be discussed to lower it below that level.
If you already have high blood pressure, you should take your blood pressure reading every day with a blood pressure monitor with an arm cuff (not a wrist or finger cuff). You should take your blood pressure monitor to your medical visit with your primary care physician once a year to be checked for proper use, accuracy and correct arm cuff size. If your blood pressure machine is battery operated, you should change the batteries every 3 months.
High Blood Cholesterol
Excess cholesterol and fat in your blood builds up in the walls of vessels that supply blood to the heart and can lead to blockages. A “lipoprotein profile”, “lipid panel” or “lipid profile” tests your levels of the key types of cholesterol—total cholesterol, LDL (“bad”), HDL (“good”) cholesterol and triglycerides, a fatty substance in the blood. You can lower your cholesterol by following a heart healthy eating plan, being physically active, maintaining a healthy weight, and, if needed, taking cholesterol lowering medication. Your doctor should order a lipid profile for you to review your cholesterol numbers and what they mean for you.
Diabetes
12-13% of Black women have been diagnosed with diabetes—and many more have diabetes and don’t know that they have it. Diabetes is a major contributor to the cause of heart disease, stroke, vision loss, loss of toes, feet and legs and kidney failure. It is the #1 cause of the need to go on dialysis in this country. Diabetes can be detected with a blood test. Changes in diet and level of physical activity can often prevent or delay the development of diabetes.
Overweight/Obesity
56% of Black women are obese4, increasing the risk not only of heart disease, but also a host of other conditions, including stroke, gallbladder disease, arthritis, and some cancers. Obesity increases the risk not only of heart disease, but also a host of other conditions, including stroke, gallbladder disease, arthritis, and some cancers. If you’re overweight, even a small weight loss will help lower your risk. At the very least, try not to gain more weight. Lasting weight loss needs a change of lifestyle—adopt a healthy, lower-calorie eating plan and get regular physical activity. Aim to lose no more than 1 pound per week.
Physical Inactivity
Many Black women are physically inactive and do no spare-time physical activity. Physical activity is crucial for good health, including heart health. Try to do at least 30 minutes of brisk/power walking on most, and preferably, all days of the week.. If you need to, divide the period into shorter ones of at least 10 minutes each.
Food Is Not Your Friend
When obesity, morbid obesity, joint pain (low back pain, hip pain, knee pain, ankle pain, foot pain), cardiovascular risk diseases (diabetes, pre-diabetes, high blood pressure, high cholesterol), heart attacks, strokes, worsening kidney failure, being on dialysis, vascular disease in the legs and feet, amputations of the lower extremities are affecting patients in varying degrees, I ultimately have to tell patients that food is not their friend anymore. Many of us eat out of boredom, engage in emotional/stress eating, and eat for taste and pleasure, instead of eating health and nutrition’s sake. However, when these disease types set in and start to escalate, you cannot continue to have the same relationship with food anymore. Eating and food are a big part of many of our social events and gatherings. The bottom line is when you are dealing with health conditions, you must change what you habitually associate with food and eating and transform the place that food has in your life. Once the atherosclerotic disease (blockages in arteries), end organ damage (organ damage from blocked arteries) and microvascular disease (blockages in the small arteries that give blood to organs) ball starts rolling down the hill, it is hard to reverse. When these diseases have started, making only small, incremental changes and “eating everything in moderation” is often no longer enough.
QUESTIONS TO ASK YOUR DOCTOR
1. What is my risk for heart disease?
2. What is my blood pressure? What does it mean for me and what do I need to do about it?
3. What are my cholesterol numbers? (These include total cholesterol, LDL, HDL, and triglycerides) What do my numbers mean for me and what do I need to do about them?
4. What are my “body mass index” (BMI) and waist measurements? Do they mean that I need to lose weight for my health?
5. What are my blood sugar level and my Hemoglobin A1C? Am I at risk for diabetes? If so, what do I need to do about it?
6. What other screening tests for heart disease do I need?
7. What can you do to help me quit smoking?
8. How much physical activity do I need to help protect my heart?
9. What’s a heart healthy eating plan for me?
10. How can I tell if I may be having a heart attack? If I think I’m having one, what should I do?
We have come a long way since 1915. Unlike Booker T. Washington, you have the opportunity to take action and lower your chance of developing heart disease and its risk factors, like high blood pressure, high cholesterol, overweight, obesity and diabetes.
References
1. National Park Service, U.S. Department of the Interior, Booker T. Washington National Monument. https://www.nps.gov/bowa/learn/historyculture/upload/the-final-btwdeath-site-bulletin.pdf
2. American Lung Association. https://www.lung.org/quit-smoking/smoking-facts/impact-of-tobacco-use/tobacco-use-racial-and-ethnic
3. American Heart Association. https://www.heart.org/en/news/2021/09/28/how-black-women-can-take-control-of-their-blood-pressure
4. Center for Disease Control 2022. Health United States, 2019.
Table 26. https://www.cdc.gov/nchs/data/hus/2019/026-508.pdf