Why is High Blood Pressure During Pregnancy More Common for Black Women?

While pregnancy is a time of excitement and anticipation, it's essential to be aware of potential health risks such as high blood pressure. Though this condition can affect many pregnant people, statistics show it's more common for Black pregnant people.

What is high blood pressure?

High blood pressure, or hypertension, occurs when the force of blood against the walls of the arteries is consistently too high. This can lead to various health problems, such as kidney disease, heart disease and stroke, if left untreated.

Blood pressure is given as two numbers. The first number, systolic, measures the pressure in your arteries when your heart beats. The second number, diastolic, measures the pressure when your heart rests between beats. Normal blood pressure for those pregnant and not pregnant is usually around 120/80.

High blood pressure during pregnancy can pose additional risks for both the mother and the baby. It is considered high when blood pressure readings consistently exceed 140/90. This condition can develop before pregnancy (chronic hypertension) or occur for the first time during pregnancy (gestational hypertension or preeclampsia).

What are the types of high blood pressure in pregnancy?

There are three main types of high blood pressure that can affect pregnant patients: Chronic hypertension, gestational hypertension and preeclampsia.

Racial disparities of high blood pressure during pregnancy

Studies have shown that Black patients are more likely to experience high blood pressure during pregnancy compared to white patients. Some reasons for this include:

• Socioeconomic factors - Economic and social factors can play a role in why high blood pressure during pregnancy is different among racial groups. Black pregnant patients are more likely to face economic hardships, limited access to quality healthcare, and reduced access to healthy food options, which can all contribute to stress and poor health results.
• Healthcare inequities - Healthcare inequities also contribute to the higher prevalence of high blood pressure among Black pregnant patients. These patients often do not receive equitable, quality of prenatal care, which is crucial for early detection and management of high blood pressure. Hidden prejudices in the healthcare system can cause delays or poor treatment.
• Genetic and biological factors - Genetic and biological factors may also play a role in the increased risk of high blood pressure among Black pregnant patients. Research suggests that certain genetic predispositions and biological responses to stress may make Black patients more susceptible to hypertension.

What are the risks of high blood pressure for Black pregnant patients?

High blood pressure during pregnancy poses several risks for Black pregnant patients. Understanding these risks can help in taking proactive measures to manage the condition effectively.

• Maternal health risks: Patients with high blood pressure during pregnancy are at greater risk for complications such as preeclampsia, eclampsia (seizures) and stroke. These conditions can have severe consequences for the mother's health and require immediate medical attention.
• Fetal health risks: High blood pressure during pregnancy can also affect the baby's health. It increases the risk of preterm birth, low birth weight and stillbirth. Babies born prematurely may face long-term health challenges, including respiratory issues and developmental delays.
• Long-term health implications: The effects of high blood pressure during pregnancy can extend beyond childbirth. Patients who experience hypertension during pregnancy are at higher risk for developing chronic hypertension and cardiovascular diseases later in life.

How can high blood pressure during pregnancy be managed?

Managing high blood pressure during pregnancy is crucial for the health of both the mother and the baby. Here are five tips and strategies to help pregnant patients manage hypertension effectively. 

1. Regular prenatal care: Regular prenatal care is essential for monitoring blood pressure and detecting any signs of complications early. Attending all scheduled prenatal appointments allows the healthcare team to assess the mother's health and make necessary interventions.
2. Healthy diet and exercise: Maintaining a healthy diet and engaging in regular physical activity can help manage blood pressure levels. Eating a balanced diet rich in fruits, vegetables, whole grains and lean proteins can promote overall health. Regular exercise, as your doctor recommends, can also improve cardiovascular health.
3. Stress management: Stress can contribute to high blood pressure. Finding effective ways to manage stress, such as practicing mindfulness, yoga or other relaxation techniques, can help lower blood pressure and improve overall well-being. It is OK, to not be “OK”. There are many mental health resources available to you.
4. Medication and treatment: In some cases, medication may be necessary to manage high blood pressure during pregnancy. Physicians and your care team will prescribe safe and effective medications to control blood pressure and minimize risks. It is important to follow the prescribed treatment plan and communicate any concerns with the care team.
5. Support and community: Having a strong support system can make a significant difference in managing high blood pressure during pregnancy. Connecting with other pregnant patients, joining support groups, and seeking guidance from healthcare experts can provide emotional support and practical advice.
6. Blood pressure monitoring: Self-blood pressure and Remote blood pressure monitoring are evidence-based ways to measure blood pressures during pregnancy and postpartum period. Ochsner patients are eligible for Ochsner Connected MOM. Through this program, they are offered a Bluetooth enabled blood pressure cuff that will upload their blood pressures to their electronic health record. This allows patients and providers to recognized uncontrolled hypertension sooner than those patients who are not enrolled.

What are the long-term effects of having high blood pressure during pregnancy? 

For many patients experiencing high blood pressure during pregnancy, once their baby is born, their blood pressure will typically go back to normal. However, patients who experience gestational diabetes or preeclampsia are at a higher risk of developing cardiovascular diseases such as heart failure, stroke and hypertension later in life. This risk increases with the severity and recurrence of preeclampsia across multiple pregnancies. A study published in the American Heart Association journal Hypertension found patients who developed preeclampsia during a single lifetime pregnancy were twice as likely to have heart failure later in life.

Because of the risks of developing cardiovascular disease later in life, it is important for patients who have gestational hypertension or preeclampsia during pregnancy to continue follow-up care with their primary care physician to monitor and manage their health. Follow-up care with your primary care physician may include:

• Postpartum blood pressure monitoring: It's important to schedule regular blood pressure checks within the first 1-2 weeks following delivery to ensure levels return to normal.
• Medication review: Your primary care physician will review and adjust dosages of high blood pressure medications as necessary.
• Follow-up appointments: Have follow-up appointments to monitor blood pressure and overall cardiovascular health, usually at six weeks postpartum and periodically after that.
• Healthy lifestyle: Adopt a heart-healthy diet low in salt and rich in fruits, vegetables, and whole grains, along with regular physical activity to help maintain normal blood pressure levels.
• Weight management: Work toward achieving and maintaining a healthy weight to reduce the risk of chronic hypertension.
• Annual screening: Get screened for chronic hypertension and other cardiovascular diseases regularly, as having gestational hypertension increases the risk of developing chronic hypertension later.
• Family planning: Discuss future pregnancy plans with your primary care physician, as gestational hypertension can recur in later pregnancies, and preconception counseling can be helpful.
• Long-term cardiovascular risk assessment: Regularly assess and manage long-term cardiovascular risks, including monitoring cholesterol levels, glucose levels and other risk factors for heart disease.

Conclusion

High blood pressure during pregnancy is a serious concern, especially for Black patients who face higher risks and disparities. Understanding the types of hypertension, the impact of racial disparities and effective management strategies can help Black pregnant patients take proactive steps to protect their health and the health of their babies.

If you're navigating pregnancy with high blood pressure, remember that you're not alone. Seeking regular prenatal care, maintaining a healthy lifestyle, and finding a supportive community can make a significant difference. By staying informed and proactive, you can manage high blood pressure effectively and enjoy a healthier pregnancy.