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The Burden of Hypertension Disparities

Yitsy Serrano

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice

Dr. Nora Hernandez-Pupo

May 17, 2025

The Burden of Hypertension Disparities

Hypertension, or high blood pressure, is a widespread population health problem that is a major risk factor for cardiovascular diseases, stroke, and premature mortality. Hypertension is not evenly distributed in the population, despite its presence in individuals from all walks of life. Racial and ethnic minorities, and in particular African Americans, are disproportionately burdened, with earlier onset, increased severity, and increased complications. In addition, socioeconomic determinants like low income, less education, and lack of insurance increase the disparities in hypertension outcomes. The disparities continue despite availability of effective prevention methods and treatment, indicating systemic barriers to availability, health literacy, and quality of care. Identification of hypertension disparities at global, country, and local levels is necessary for planning health promotion programs that are both equitable and effective. The awareness of hypertension disparities on several different levels is examined in this paper, and the foundation is set for a health promotion program proposal.

Global Relevance of Hypertension Disparities

Hypertension is a worldwide health emergency and a top cause of mortality around the world. Based on the estimation by Moloro et al., (2023), there are around 1.28 billion adults aged 30–79 years with hypertension worldwide, of whom two-thirds reside in the low- and middle-income countries (LMICs). Hypertension remains undiagnosed and uncontrolled in most of these areas due to poor health infrastructure, limited availability of medication, and poor health systems. Inequalities in the control of hypertension are most visible in the African and South Asian regions, with alarmingly low rates of awareness and treatment. For instance, Shakil et al. (2022) reports that merely 17% of those with hypertension in sub-Saharan Africa have their blood pressure controlled. Even gender inequalities are high, with men in most areas less willing to receive medical treatment or comply with treatment schedules. The worldwide trends, therefore, demonstrate the need for integrated, culturally specific health intervention that can mitigate the burden of hypertension in different groups of individuals.

Furthermore, globalization and urbanization have increased the burden of hypertension in hitherto low-risk groups. Consumption of processed food, sedentary behavior, and stress have all boosted rates of hypertension in city dwellers in developing nations. According to Mills et al., (2020), from 1975 through 2015, the prevalence of increased blood pressure declined in high-income nations but rose in most developing areas, including regions of Africa and South Asia. International policy lags, along with the uneven distribution of health resources, also contribute to the world inequality of hypertension outcomes. If there are not specifically focused public health efforts, the inequalities are expected to increase, causing an increased global health and economic burden of undiagnosed hypertension and its sequelae.

National Relevance of Hypertension Disparities

In the United States, hypertension affects nearly half of the adult population—approximately 122 million people as reported by the Centers for Disease Control and Prevention (CDC, 2025). However, this burden is unequally distributed. African Americans have the highest prevalence of hypertension compared to any other racial or ethnic group in the U.S. Not only are they more likely to develop hypertension at an earlier age, but they are also more likely to experience related complications such as stroke, kidney disease, and heart failure. According to Ferdinand et al. (2021), around 56% of non-Hispanic Black adults have hypertension, compared to 48% of Whites and 39% of Hispanic adults. This disparity is partly attributed to a combination of genetic predispositions, structural racism, socioeconomic status, and limited access to quality healthcare.

Additionally, insurance coverage and education levels significantly impact hypertension outcomes in the U.S. Uninsured individuals are less likely to receive regular blood pressure screenings or adhere to medication regimens. Studies show that individuals with less than a high school education are at higher risk of uncontrolled hypertension due to lower health literacy. Flaubert et al., (2021) emphasizes that these disparities contribute to avoidable healthcare costs and poor population health outcomes. In response, national health initiatives like “Million Hearts 2027” aim to reduce disparities by promoting clinical-community linkages and equitable access to preventive services. However, sustained effort is necessary to address the root causes of hypertension inequities at the systemic level.

Local Relevance and Perspective

In Chicago, Illinois, hypertension remains one of the most prevalent chronic conditions, disproportionately affecting communities of color and low-income neighborhoods. Abrahamowicz et al., (2023), approximately 36% of African American adults in the city have been diagnosed with hypertension, compared to 23% of White adults. These disparities are concentrated in South and West Side neighborhoods, which face long-standing structural barriers to health. Contributing factors include limited access to affordable healthcare, higher levels of neighborhood violence and stress, and fewer resources for nutritious food and physical activity. Many of these areas are federally designated “food deserts,” where residents must travel long distances to find fresh produce, making it difficult to adhere to dietary recommendations that help manage blood pressure.

Healthcare institutions in Chicago also struggle to meet the needs of the city’s underserved populations. Safety-net hospitals and community health centers are often underfunded and overburdened, leading to inconsistent care and limited hypertension follow-up. According to CDPH data, nearly 58% of patients with uncontrolled hypertension in Chicago are from households earning below the federal poverty level, with a disproportionate share identifying as Black or Hispanic. Language barriers, mistrust of medical systems, and transportation issues further compound access challenges. In response, initiatives like the Healthy Chicago 2025 plan and West Side United have introduced mobile health units, community-based screenings, and neighborhood wellness campaigns. These interventions have shown early promise in improving hypertension awareness and treatment adherence. However, to significantly reduce disparities, more integrated and sustained public health investments are needed that address both clinical care and the social determinants driving hypertension in vulnerable Chicago communities.

Promoting Equity in Hypertension Prevention

Due to the worldwide, nationwide, and local burden of hypertension disparities, there is a clear need for integrated health promotion activities that are specific to affected groups. They should be supported by cultural competence, health equity, and community involvement. Interventions addressing social determinants of health—education, income, and environment—should be deployed in order to mitigate hypertension outcomes. Widespread screening, diet and lifestyle education, enhanced availability of affordable medication, and arrangements with credible community-based organizations are essential in programs. At global, nationwide, and local levels, health professionals can alleviate the burden of hypertension and narrow the gap in health outcomes in diverse populations by applying interventions that act in several domains. Creating an inclusive and responsive health promotion program not only saves lives but also supports the overall objective of health equity.

References

Abrahamowicz, A. A., Ebinger, J., Whelton, S. P., Mensah, Y. C., & Yang, E. (2023). Racial and ethnic disparities in hypertension: Barriers and opportunities to improve blood pressure control. Current Cardiology Reports, 25(1), 17–27. https://doi.org/10.1007/s11886-022-01826-x

CDC. (2025, January 28). High blood pressure facts. High Blood Pressure. https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html

Ferdinand, K., Batieste, T., & Fleurestil, M. (2021). Contemporary and Future Concepts on Hypertension in African Americans: COVID-19 and Beyond. Journal of the National Medical Association, 112(3), 315–323. https://doi.org/10.1016/j.jnma.2020.05.018

Flaubert, J., Menestrel, S., Williams, D., & Wakefield, M. (2021). Social determinants of health and health equity. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573923/

Mills, K. T., Stefanescu, A., & He, J. (2020). The Global Epidemiology of Hypertension. Nature Reviews Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2

Moloro, A. H., Seid, A. A., & Jaleta, F. Y. (2023). A systematic review and meta-analysis protocol on hypertension prevalence and associated factors among bank workers in Africa. Sage Open Medicine, 11, 205031212311720-205031212311720. https://doi.org/10.1177/20503121231172001

Shakil, S., Ojji, D., Longenecker, C. T., & Roth, G. A. (2022). Early Stage and Established Hypertension in Sub-Saharan Africa: Results From Population Health Surveys in 17 Countries, 2010–2017. Circulation-Cardiovascular Quality and Outcomes, 15(12). https://doi.org/10.1161/circoutcomes.122.009046