Disparities persist in Black adults’ stroke risk

According to the American Heart Association (AHA), significant disparities for stroke risk factors exist between Black adults and non-Black adults who have had a stroke.

Research findings published in AHA’s Stroke found that major differences were seen at enrollment in the study for Black participants compared to their non-Black counterparts. Black participants had a younger age (57.5 years old versus 61 years old), and they had more high BP at study enrollment (95.2% vs. 87.5%), more T2D at enrollment (52.9% vs. 39.7%), higher average diastolic BP (82.4 vs. 79.5 mm Hg), and low physical activity PACE score (2.7 vs. 3.3). (A PACE score of 4 or above is considered moderately active and within target range.)

“Modifiable stroke risk factor differences between Black and non-Black adults were found at enrollment; however, our study found these disparities may be resolved by tailoring care to include lifestyle coaching, medication alterations or additions if appropriate, access to routine health care support and regular physician follow-up,” said study coauthor Ashley Nelson, DO, in a press statement. “Intense risk factor management has an important role in improving or eliminating these risk factor disparities in Black adults.”

However, after 1 year of intensive medical intervention, some of the risk factors that increase the risk of stroke were reduced in the Black adults, according to research. Specifically, the average diastolic BP in Black adults dropped to 74.7 mm Hg, compared to 75.5 mm Hg in all other participants and the average PACE score increased among Black adults to 4.2 from 2.7. In comparison, the average PACE score among non-Black adults was 4.1, and the percentage of diuretic medication use doubled in Black adults. Researchers speculate that the increased use of thiazide diuretics may explain the notable decrease in average diastolic BP.

For the analysis, researchers examined health data from the SAMMPRIS randomized controlled trial conducted from 2008–2011 at 50 sites within the United States. They evaluated medication use and vascular risk factors, such as systolic BP, diastolic BP, low-density lipoprotein, blood glucose levels, and physical activity of Black and non-Black adults with a recent stroke event.

The non-Black participant group included white, Asian, and Hispanic adults, who were measured collectively.

The authors note that their research raises questions about other factors beyond physiology, medications, and regular follow-up that may help to reduce these disparities even further.

“Many different approaches are needed to reduce and eliminate these disparities in Black adults,” Nelson said. “Access to health care, lifestyle coaching, early follow-up, and administration of appropriate medications after stroke may help to resolve it, but not wholly in terms of overall risk and all of the baseline disparities.”