Black women developed hypertension up to 9.6 years earlier than White women in a national US cohort, and this disparity persisted even in less-disinvested neighborhoods, according to a study published on Jul. 3. The findings highlight the need for earlier prevention strategies and action on structural drivers of cardiovascular health inequities.
The research, published in JAMA Network Open, found that hypertension occurred almost a decade earlier in Black women compared with White women across all levels of neighborhood disinvestment. High blood pressure is recognized as a major contributor to cardiovascular disease, particularly affecting women who experience faster rises in blood pressure over their lifetimes and face greater risks related to cardiovascular mortality.
The study examined data from 15,313 participants—46% identifying as Black and the remainder as White—in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Participants were assessed at home between 2003-2007 and again between 2013-2016. Hypertension onset was identified by self-reported age at physician diagnosis or first measured high blood pressure during the study.
Neighborhood disinvestment was estimated using socioeconomic scores based on household income, housing unit value, educational status, and occupation at the census-tract level. Most Black women (49.5%) lived in highly disinvested neighborhoods while nearly half of White women (48.3%) lived in less-disinvested areas. Over follow-up, hypertension developed in 71.7% of participants overall but was more common among Black women (82.7%) than White women (62.2%), as well as among those living in highly disinvested neighborhoods compared with less-disinvested ones (80.4% vs 62.5%).
After adjusting for socioeconomic characteristics such as income and education—as well as health-related factors like exercise—Black women developed hypertension at a median age of 56 versus 66 years for White women; this gap remained across all levels of neighborhood investment.
The authors said these findings are consistent with chronic stress beginning early in life along with accumulated disadvantage: “Taken together, these factors may potentially lead to cumulative physiological wear and reduced resilience over the life course,” they said. They suggest prevention efforts should begin early and address structural inequalities beyond neighborhood conditions.
