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    I have Good news and Bad news

    by Ngozi Osuagwu, MD | July 14th, 2019

    I have Good news and Bad news

    I hate when I am asked the following question –  “I have got good news and I have got bad news, which do you want to hear first?” If I hear the bad news first, sometimes it is so bad that I never really hear the good news that comes afterwards. If I start with the good news first, when I hear the bad news, I often forget the good news. When it comes to high blood pressure in black women, there is good news and bad news, but I will not ask you which you would like to hear first. What I am going to do is give you the good news, then the bad news and then the good news.

    The good news is that when it comes to high blood pressure, black women have the:

    • Highest rate of awareness – they have been diagnosed with high blood pressure and they know they have it.
    • Highest rate of treatment – they are on medication for high blood pressure

    The bad news is the black women have the:

    •  Lowest rate of control – their blood pressure is not in the normal range. High blood pressure and hypertension are the same. When the blood pressure is not controlled, it is called uncontrolled hypertension. Uncontrolled hypertension affects several organs in the body. It can lead to problems with the heart (enlarged left heart and heart failure), problems with the brain (stroke and dementia), problems with the kidney (kidney failure), problems with the eyes (nerve damage and blindness), and sexual problems (decrease blood flow to the vagina).

    This explains why black women are more likely to die of heart disease than any other ethnic group.


    Why is the blood pressure not controlled? According to Dr. Ogedegbe, it has more to do with the social determinants of health rather than genes. In an article he wrote, he listed barriers in three main categories – patient-related barriers, physician-related barriers, and factors related to the medical environment or health care system.

    Below, I have listed the patient-related barriers and next to it I have provided in bold what can be a solution and that is the good news. I believe that each of us whether or not we have high blood pressure can be part of the solution.

    • Patients do not always take their medications as prescribed – take your medication as prescribed. If you do not understand how to take your medication, ask questions. You can also talk with the pharmacist. High blood pressure is a silent disease. By the time you have the symptoms of uncontrolled high blood pressure, it is probably too late.
      • Patients do not always follow the recommended lifestyle changes to help reduce blood pressure – Lifestyle changes makes a difference in controlling high blood pressure. The American Heart Association has Life’s Simple 7®. There is also the Dietary Approaches to Stopping Hypertension (DASH) diet. I am amazed at how many people who have been diagnosed with hypertension are not aware of the DASH diet. The DASH diet is also great for those that do not have high blood pressure.
      • The medications can be expensive and patients cannot afford to take the medication – You can ask your physician for a cheaper alternative to the medication that was prescribed. You can also go on Good Rx and see if the medication is cheaper.
      • Mistrust of the health care system – Racism exists everywhere and the health system is not immune. Avoiding the health system is not the way to make changes. Our health is important. I will tell you, the majority of health care providers truly want to care for their patient regardless of what makes their patient different from them. Use your voice and ask questions. If you do not have a good relationship with your physician, then may be it is time to change. Your health is too important. You want your doctor to listen to you.
      • Medication side effects not tolerated and patients stop the medication – Do not stop your medication without talking with your health care provider. They need to be aware of what is happening. They cannot read minds. You must use your voice. There are several medications to treat high blood pressure. There will be one that works for you.
      • Poor health literacy – Not understanding clearly the importance of what it means to have the blood pressure under control. There are so many tools to learn about your disease. You can ask your health care provider, you can google, you can go to the library and check out a book, you can ask the office for pamphlets. Learn about your disease.
      • Psychosocial factors like stress, anxiety and depression – Life happens. We know that health is more than just what affects our physical body. Our mind and spirit plays a role. Use your breath to help with stress. Gratitude exercises are helpful. Exercise is helpful. Do not be afraid to take medication for anxiety and depression. These are medical problems.

    Awareness (know your numbers), treatment (take your medications) and control (monitor yourself to make sure that the blood pressure in under control) are the keys to living with hypertension but not having it cause problems later on in life.

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