Hypertension In Black Women Research Articles

Addressing Racial Disparities in the Hypertensive Disorders in Pregnancy: A Plan for Action from the Preeclampsia Foundation's Racial Disparities Task Force.

Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal mortality in the United States, with Black women and birthing people disproportionately having higher HDP-related deaths and morbidity. In 2020, the Preeclampsia Foundation formed a national Racial Disparities Task Force (RDTF) to identify key recommendations to address issues of racial disparities related to HDP. Recommendations are centered around the Foundation's three pillars: Community, Healthcare Practice, and Research. Healthcare practices include adequate treatment of chronic hypertension in Black women and birthing people, re-branding low-dose aspirin to prenatal aspirin to facilitate uptake, and innovative models of care that especially focus on postpartum follow-up. A research agenda that examines the influence of social and structural determinants of health (ssDOH) on HDP care, access, and outcomes is essential to addressing disparities. One specific area that requires attention is the development of metrics to evaluate the quality of obstetrical care as it relates to racial disparities in Black women and birthing people with HDP. The recommendations generated by the Preeclampsia Foundation's RDTF highlight the strategic priorities and are a call to action that requires listening to the voices and experiences of Black women and birthing people, engaging their communities, and multi-sectoral collaboration to improve healthcare practices and drive needed research.

Resting Sympathetic Transduction in Young Healthy non‐Hispanic Black Women: Potential Race and Sex Differences

BackgroundThe prevalence of hypertension (HTN) is highest in the non‐Hispanic Black (BL) population. Notably, BL women have an equal or greater HTN prevalence compared to BL men; however, limited studies have included women. Heightened sympathetic nervous system reactivity has been proposed as a potential mediator of elevated HTN risk in the BL population. In this regard, our laboratory previously demonstrated exaggerated sympathetic transduction at rest in young normotensive BL men compared to their non‐Hispanic white (WH) counterparts. Whether similar responses are present in BL women is not known. Furthermore, whether there are sex differences in sympathetic transduction in young BL adults remains unclear.HypothesisWe hypothesized that BL women would exhibit elevated resting sympathetic transduction compared to WH women, and that sympathetic transduction would be comparable between BL women and men.MethodsSix young healthy BL women (age: 20 ± 1 years), six WH women (age: 21 ± 1 years) and six BL men (age: 21 ± 1 years) were studied. Heart rate (ECG), muscle sympathetic nerve activity (MSNA; peroneal microneurography) and beat‐to‐beat blood pressure (BP; Finometer) were continuously measured under resting conditions for 19 ± 1 min. Sympathetic transduction was quantified as peak changes in mean arterial pressure (MAP) and the nadir of total vascular conductance (TVC) over 10 cardiac cycles following spontaneous bursts of MSNA using signal‐averaging. All data are expressed as mean ± SEM.ResultsResting BP and heart rate were not different between groups (all P > 0.05). Likewise, BL women had similar MSNA burst frequency (BL women: 12 ± 2 vs. WH women: 14 ± 1 bursts/min; P = 0.475) and burst incidence (BL women: 21 ± 2 vs. WH women: 24 ± 2 bursts/100 cardiac cycles; P = 0.477) compared to WH women, and BL men (13 ± 1 bursts/min, 21 ± 1 bursts/100 cardiac cycles; P = 0.539). For peak increases in MAP following MSNA bursts, there were no differences between BL and WH women (BL women: Δ+2.3 ± 0.4 vs. WH women: Δ+2.1 ± 0.2 mmHg; P = 0.741). Peak reductions in TVC were also not different in women (BL women: Δ‐2.1 ± 0.3 vs. WH women Δ‐2.4 ± 0.6 mL/min/mmHg; P = 0.966). However, in comparison to BL men, BL women had lower MAP (women: Δ+2.3 ± 0.4 vs. men: Δ+5.5 ± 1.1 mmHg; P = 0.011) and TVC (P = 0.036) responses.ConclusionContrary to our hypothesis, these preliminary data suggest similar beat‐to‐beat sympathetic transduction at rest in BL and WH women. Interestingly, sympathetic transduction at rest was lower in BL women compared to BL men highlighting a potential differential effect of sex on BP regulation in young BL adults. Collectively, these findings suggest that augmented sympathetic transduction is not likely an early contributor to the greater prevalence of HTN in BL women.

Antihypertensive medication adherence and persistence among Black women: A qualitative study.

The prevalence of hypertension in Black women (57.6%) is among the highest in the world. Many of those who identify as Black do not readily adhere to prescribed antihypertensive medications nor persist with long-term therapy. This qualitative study describes self-reported approaches used by Black women with consistent adherence and persistence to medication-taking for BP control.

Stress interventions and hypertension in Black women.

Hypertension is a risk factor for cardiovascular disease. Black women have high rates of hypertension compared to women of other racial or ethnic groups and are disproportionately affected by psychosocial stressors such as racial discrimination, gender discrimination, and caregiving stress. Evidence suggests that stress is associated with incident hypertension and hypertension risk. Stress management is associated with improvements improved blood pressure outcomes. The purpose of this review is to synthesize evidence on effects of stress management interventions on blood pressure in Black women. A comprehensive search of scientific databases was conducted. Inclusion criteria included studies that were: (1) primary research that tested an intervention; (2) in the English language; (3) included African-American women; (4) incorporated stress in the intervention; (5) included blood pressure as an outcome; and (6) were US based. Eighteen studies met inclusion criteria. Ten (56%) studies tested meditation-based interventions, two (11%) tested coping and affirmation interventions, and six (33%) tested lifestyle modification interventions that included stress management content. Thirteen of the studies were randomized controlled trials. Reductions in blood pressure were observed in all of the meditation-based interventions, although the magnitude and statistical significance varied. Comprehensive lifestyle interventions were also efficacious for reducing blood pressure, although the relative contribution of stress management versus behavior modification could not be evaluated. Coping and affirmation interventions did not affect blood pressure. Most of the reviewed studies included small numbers of Black women and did not stratify results by race and gender, so effects remain unclear. This review highlights the urgent need for studies specifically focusing on Black women. Given the extensive disparities in cardiovascular disease morbidity and mortality, whether stress management can lower blood pressure and improve primary and secondary cardiovascular disease prevention among Black women is an important question for future research.

An interactive technology enhanced coaching intervention for Black women with hypertension: Randomized controlled trial study protocol.

In the United States, hypertension (HTN) is the leading risk factor for cardiovascular disease, and a more significant health problem for Blacks compared with other racial/ethnic groups. The prevalence of HTN in Black women is among the highest in the world, underscoring the need for effective prevention and management approaches for blood pressure (BP) control. We developed a two-arm randomized controlled trial repeated measures design study for improving HTN self-management among Black women. The study tests whether the Chronic Disease Self-Management Program (CDSMP) combined with interactive technology-enhanced coaching, can improve BP control and adherence to treatment (e.g., medication-taking, physical activity, calorie intake, and weight management) compared with the CDSMP alone. Repeated measurements were conducted at 3, 6, and 9 months. A sample of 90 community-dwelling Black women with uncontrolled Stage 1 HTN (BP ≥ 130/80) were enrolled, completed CDSMP training, and randomized. This study will contribute to our understanding of novel methods to empower Black women to increase their active involvement in self-care management of HTN.

The associations among illness perceptions, resilient coping, and medication adherence in young adult hypertensive black women.

Hypertension, a modifiable risk factor of cardiovascular disease, is largely responsible for the disproportionate morbidity and mortality in black women. Black women 20years of age and older have a higher prevalence of HTN compared to white women (44% vs 28%). Poor adherence and non-adherence to hypertensive medications have been strongly indicated as a primary contributor to the early onset of disparity in cardiovascular disease morbidity and mortality experienced by black people. The purpose of this study was to examine medication adherence in black women relative to sociodemographic, clinical, cultural context, psychosocial, cognitive, and behavioral factors. This was a prospective, descriptive cross-sectional study of N=85, hypertensive black women, with mean age of 39±5.4years, 18-45years of age. Variables and measures included: sociodemographic characteristics, clinical, adverse social stressors, psychosocial, cognitive-behavioral factors, and medication adherence. Descriptive statistics, correlations, multivariate logistic regressions, and moderation analysis were tested. 81.2% (n=69) of the sample was categorized as non-adherent. SBP was the only clinical covariate associated with HTN medication adherence. HTN illness perceptions, composite score, resilient coping, depressive symptoms, exposure to lifetime gender, and racial stressors, were not associated with HTN medication adherence. Using multivariate logistic regression, decreased SBP and lower scores on the "Consequence" dimension of the HTN illness perception scale were associated with medication adherence (χ2 =10.53, P=.001). Adherence was associated with both the "Consequence" and "Identity" dimensions of the HTN illness perception scale indicating the need and importance for clinicians to have open and honest communication regarding HTN and its treatment in facilitating adherence.

Stress, adherence, and blood pressure control: A baseline examination of Black women with hypertension participating in the SisterTalk II intervention.

The prevalence of hypertension is highest among Black women, but treatment adherence is reportedly low. Stress unique to the experiences of Black Americans may be associated with low adherence and poor blood pressure control, but few studies have examined the relationships between stress, adherence, and blood pressure control among hypertensive Black women. This study seeks to fill gaps in research by examining the association between stress, adherence, and blood pressure control. The baseline sample (n = 571) of at-risk or hypertensive Black women from the SisterTalk II RCT (Northeastern USA, 2004–2006) to improve adherence to recommendations for hypertension was analyzed. Participants self-reported stress, pharmacological adherence, non-pharmacological adherence (i.e. lifestyle management such as diet and exercise), and demographics. Blood pressure and anthropometrics (BMI and waist circumference) were measured. Statistical analysis included ANOVA, t-tests, linear regression. Tests of mediation examined if adherence mediated the relationship between stress and blood pressure control. This study found that stress was associated with lower age (p < .001) and being a single parent (p < .001). Stress was also associated with higher systolic blood pressure (p = .029), and poor blood pressure control (p = .043). Participants who reported higher stress also reported lower non-pharmacological adherence (p = .042). Non-pharmacological adherence was found to mediate the association between stress and blood pressure control. Hence, results document a relationship between stress with non-pharmacological adherence and blood pressure control among Black American women. More research is necessary to examine the relationship between stress and treatment adherence.

Abstract P327: Stress Overload and Methylation of Hypertension Related Genes

Background: Nearly 30% of U.S. adults are hypertensive with a high prevalence existing among Black Americans (42%). Exposure to psychosocial stress has been identified as a risk factor for hypertension and may explain part of the observed racial disparities. One pathway through which stress exposure may mechanistically alter biological functioning in a manner that affects risk of hypertension is via epigenetic modifications in hypertension-related genes, but this area remains understudied. Aims and Hypothesis: In the present study, we investigate the relationship between stress exposure and methylation of 25 genes that have been associated with blood pressure in Blacks in previous genetic research. We hypothesize that stress exposure is associated with DNA methylation of blood pressure related genes. Methods: We conducted an epigenetic association study using data from the ongoing InterGEN Study, a longitudinal investigation of the psychological, environmental, and genetic factors that contribute to hypertension risk in African American mothers (n=74) and their young children. Stress exposure was measured using the 24-item Stress Overload Scale (α=0.95), and a summary score was calculated by summing the Likert scale responses. Methylation was measured using the Illumina Infinium MethylationEPIC Beadchip, and M-values (i.e. log2 ratio of the intensities of methylated probe versus unmethylated probe) were calculated for association analysis. Linear regression was employed to assess the association between stress exposure and methylation in the a priori defined genes. Results: At p&lt;0.05, we identified 45 methylation sites associated with stress overload. These sites represented 17 of the 25 investigated genes. The most statistically significant sites were related to the genes: insulin like growth factor binding protein 3 ( IGFBP3 ), calcium voltage-gated channel subunit alpha1 H ( CACNA1H ), and solute carrier family 4 member 5 ( SLC4A5 ) (p=0.001, p=0.002, and p=0.006, respectively). Conclusion: This study provides biological insight into DNA methylation as a mechanism whereby exposure to psychosocial stress affects risk of hypertension in Black women. Additional replication studies with a larger sample size and includes men are needed to validate and generalize the findings. Future research should further investigate the biological mediators between DNA methylation and hypertension manifestation.

Treadmill Exercise Responses in Newly Diagnosed Hypertensive African Women

Black women comprise the demographic group with the highest prevalence, earliest onset and longest duration of hypertension, contributing to Black women having the highest lifetime risk of heart failure (HF). To unveil potential hypertension-related mechanisms that may lead to HF in Black women, we compared exercise responses of normotensive and newly diagnosed hypertensive Black women.

Abstract P192: Psychosocial Correlates of Adherence to Non-pharmacological Therapy: An Examination of Baseline Results From the SisterTalk Adhere Intervention for Black Women

Significance: Non-pharmacological treatment for blood pressure, such as dietary and Physical Activity (PA) adherence, is a key determinant of effective blood pressure management. Psychosocial variables such as self-efficacy, outcome expectations and motivation to engage in health behavior have been reported to be predictors of non-pharmacological adherence. However, few studies have studied these constructs among minority and at-risk populations such as hypertensive Black American women. Identifying psychosocial correlates of adherence is key to the development of efficacious interventions to improve adherence and overall health outcomes. Methods: We examined baseline measures (n = 323) of a sample of self-reported hypertensive Black women from SisterTalk Adhere , a randomized controlled trial to promote weight loss for hypertension control. Independent variables include (1) self-efficacy, (2) outcome expectations and (3) motivation for health behavior (further divided into PA and diet domain specific) Dependent variables are dietary and PA non-pharmacological adherence (operationalized as “none/some/most/all of the time” for diet and PA adherence in the past 4 weeks). Results: The mean age of the sample was 52.17±10.32. Regression analyses revealed that age was significantly associated with dietary adherence ( p = .037). Dietary self-efficacy and positive outcome expectations from healthy eating were significantly associated with dietary adherence (both p &lt; .001). Motivation for healthy eating was also significantly associated with dietary adherence ( p = .043). Self-efficacy for PA and positive outcome expectations from PA were significantly associated with PA adherence ( p = .006 and p &lt; .001 respectively). Motivation for PA was not found to be associated with PA adherence. Conclusion: Results suggest that self-efficacy, outcome expectations and motivation for health behavior may be important targets to improve engagement in health behavior and non-pharmacological adherence among hypertensive Black women.

Illness Perceptions and Health Behaviors of Black Women

The Common Sense Model of Illness Representations proposes that representations or perceptions of illness drive health behaviors. The purpose of this study was to explore the relationships between hypertension representations, exercise, and dietary behaviors in hypertensive black women (N = 204, aged 18-65 years). Regression results revealed that perceiving hypertension as chronic and perceiving it a result of environmental causes were inversely related to moderate-intensity physical activity (β = -.15 [P = .05] and β = -.25 [P = .05], respectively). Having more emotional responses to hypertension (β = .23, P = .05) was related to moderate-intensity physical activity and more fruit and vegetable consumption (β = .28, P = .05). These findings suggest that hypertension representations can interfere with recommended lifestyle changes among black women. Assessing hypertension representations and implementing measures to clarify misperceptions of hypertension among black women may lead to better blood pressure control and health outcomes.

PM2.5 exposure and incident diabetes and hypertension: Preliminary results from the Black Women’s Health Study

Background. Laboratory evidence suggests that fine particulate matter PM2.5 may contribute to the genesis of chronic conditions like diabetes and hypertension. Although air pollution has been associated with the prevalence of these conditions, the few epidemiologic data on its relation to incident diabetes and hypertension have been inconsistent. Aims. We assessed the association of ambient PM2.5 and incident type 2 diabetes and hypertension in the Black Women’s Health Study (BWHS), a follow-up study of African American women. Methods. BWHS participants reported incident diabetes and hypertension on biennial questionnaires from 1995-2011. We estimated long-term average PM2.5 levels at participant addresses from 1998-2009 in 56 cities across the U.S. using a hybrid model combining land use regression and Bayesian Maximum Entropy kriging. We used Cox regression models to estimate city-specific hazard ratios (HR) associated with a 1.75 µg/m3 increase in PM2.5, the mean interquartile range in the major cities. City-specific HRs were then pooled in a summary estimate. Results. Of 33,621 women free of diabetes in 1995, 4078 developed diabetes over 16 years of follow-up; of 32,638 hypertension-free women in 1995, 9588 developed hypertension. The age-adjusted HR for diabetes was 1.09 (95% CI 1.03-1.15). After control for age, body mass index, and neighborhood socioeconomic status, it was 1.02 (95% CI 0.96-1.08). For hypertension, the respective HRs were 1.03 (95% CI 1.00-1.07) and 0.98 (95% CI 0.95-1.02). Conclusions. These results do not provide evidence of an association between PM2.5 and incident diabetes or hypertension in black women. Future work will assess the effects of traffic-related air pollutants, which were previously associated with incident diabetes in BWHS participants living in Los Angeles (Coogan et al., Circulation 2012;125:767-772).

The impact of race and comorbidity on survival in endometrial cancer.

Poorer survival from endometrial cancer in blacks than in whites is well documented. The aims of this study were to determine whether diabetes, hypertension, or other conditions influence survival and whether accounting for these conditions reduces this racial disparity. Using the SEER-Medicare database, we investigated the influence of diabetes, hypertension, and other comorbid conditions on survival in black and white women age ≥66 with endometrial cancer. We used Cox proportional hazards regression to evaluate the influence of comorbidities on survival for blacks and whites separately and to study survival differences between blacks and whites after adjustment for diabetes, hypertension, and other medical conditions, as well as for demographics, tumor characteristics, and treatment. In both racial subgroups, women with diabetes or other conditions had poorer overall survival, whereas hypertensive black women experienced better survival [HR, 0.74; 95% confidence interval (CI), 0.60-0.92]. For disease-specific survival, diabetes was associated with poorer survival in white women (HR, 1.19; 95% CI, 1.06-1.35) but not in blacks (HR, 0.97; 95% CI, 0.73-1.30); hypertension and other conditions were not significantly related to survival. After adjustment, black women had poorer survival than white women, with HRs of 1.16 (95% CI, 1.05-1.28) for overall and 1.27 (95% CI, 1.08-1.49) for disease-specific survival. Diabetes influences disease-specific survival in white women but not in blacks. The racial disparity in survival is not explained by the presence of other health conditions. Further research should focus on the unknown factors that lead to poorer survival in black women compared with whites.

Rotating night shift work and disparate hypertension risk in African-Americans.

Hypertension disproportionally affects black compared with white Americans, even after accounting for known risk factors. Circadian disruption as encountered by rotating night shift workers has been associated with an increased risk for hypertension. Because blood pressure responds differently to sleep alterations in blacks compared with whites, we hypothesized that rotating night shift work may be a stronger risk factor for hypertension among blacks. We prospectively examined the association between rotating night shift work and the risk of hypertension in 1510 black and 94 142 white female participants of the Nurses' Health Study II who were nonhypertensive at baseline in 1991. We used Cox proportional hazards models to control for potential confounders. During 16 years of follow-up (1991-2007), we identified 580 incident cases of hypertension in blacks and 23 360 cases in whites. In blacks, the multivariable hazard ratio for incident hypertension among women who worked rotating night shift for more than 12 months in the previous 2 years was 1.81 [95% confidence interval (CI) 1.14-2.87], compared with those working none. By contrast, in whites, we observed no increase in risk (hazard ratio 0.99, 95% CI 0.93-1.06). The association between shift work and hypertension varied significantly by race (P interaction = 0.01). In secondary analyses, the multivariable hazard ratio for incident hypertension in black women who ever performed rotating night shift work was 1.46 (95% CI 1.07-1.99), compared with those never working rotating night shifts. In whites, there was no increase in risk (hazard ratio 0.97, 95% CI 0.93-1.01) (P interaction < 0.01). Rotating night shift work is independently associated with an increased risk of hypertension in blacks but not in whites.

Circulating Inflammatory and Endothelial Markers and Risk of Hypertension in White and Black Postmenopausal Women

Systemic inflammation and endothelial activation are implicated in the development of hypertension. However, epidemiologic studies have yet to compare multiple corresponding biomarkers in relation to risk of hypertension, particularly in multiethnic populations. We identified 800 individuals with incident hypertension and 800 matched controls, each group with equal numbers of white and black women, in a nested case-control study within the Women's Health Initiative Observational Study. We measured markers of inflammation [high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-6, IL-1β, tumor necrosis factor receptor 2 (TNF-r2)] and endothelial activation [soluble intercellular adhesion molecule-1 (sICAM-1)] in baseline blood samples. Before adjustment for measures of adiposity, higher hsCRP and IL-6 concentrations were associated with increased risk of hypertension in both white and black women, higher TNF-r2 was associated with increased risk of hypertension in black women only, and IL-1β and sICAM-1 were not associated with risk of hypertension. All the positive associations were attenuated after adjustment for body mass index. The resulting multivariable-adjusted relative risks (95% CI) of hypertension comparing the highest vs lowest quartile were 1.52 (0.94-2.48) and 1.23 (0.76-1.97) for hsCRP and IL-6 in white women and 1.30 (0.81-2.07), 1.58 (0.96-2.59), and 1.49 (0.94-2.36) for hsCRP, IL-6, and TNF-r2 in black women. The results after adjustment for waist circumference were similar. After adjustment for measures of adiposity, there was no significant association of hsCRP, IL-6, IL-1β, TNF-r2, or sICAM-1 with incident hypertension in either white or black women. The interrelationships between inflammation and adiposity in development of hypertension need further investigation.

Treating the Black Hypertensive in 2010: Achieve Lower Targets While Awaiting More Definitive Evidence

Treating the Black Hypertensive in 2010: Achieve Lower Targets While Awaiting More Definitive Evidence

The association between obesity and hypertension in blacks.

The relationship between obesity (or overweight) and hypertension among blacks warrants careful consideration because of the substantial prevalence of both obesity and hypertension in the black population. Based on the relative risks of hypertension for overweight and nonoverweight persons in the 1976-1980 U.S. National Health and Nutrition Examination Survey, 21% of hypertension in black men and 18% of hypertension in black women can be attributed to overweight. In terms of numbers affected, approximately 330,000 cases of hypertension among black men and 500,000 cases of hypertension among black women in the 25- 74-year age range may be related to obesity. Thus, although several sources suggest that obesity is less strongly associated with hypertension in blacks than whites, obesity clearly plays a significant role in hypertension in blacks. The benefits of weight loss for black hypertensives may include not only reduction in blood pressure but also--as an independent effect--regression of left ventricular hypertrophy, which is also excessively prevalent in blacks compared with whites. Weight control and weight reduction warrant high priority in treatment regimens for overweight black hypertensives.

Hypertension in Women—Part II

In Part I, we reviewed the pathophysiology of hypertension in women. This section focuses on the treatment of hypertension in special circumstances and special populations: pregnancy, preeclampsia, and lactation; hypertension in black women; and hypertension in the elderly.

Relationship of health behavior theories with self-efficacy among insufficiently active hypertensive African–American women

Objective While self-efficacy plays an important role in physical activity, relatively little research has examined this construct in minorities. This study identified theoretical correlates associated with self-efficacy among insufficiently active, hypertensive Black women. Methods Correlates of self-efficacy to: (1) overcoming barriers to physical activity; (2) making time for activity; and (3) “sticking with” physical activity were studied. Results Sixty-one women ( M = 50.48 ± 4.2 years) participated. We accounted for 32% of the variance in confidence in overcoming barriers. Women confident in overcoming barriers reported less worry about physical activity. The TTM processes of change were also in the model: consciousness raising, environmental reevaluation, counter conditioning, and self-liberation. We accounted for 16% of the variance in “making time” self-efficacy. An aversiveness barrier (e.g., physical activity is boring, physical activity is hard work) was the dominant variable in the model. Confidence to ‘stick with’ physical activity was associated with self-reevaluation (i.e., reflection on how personal values correspond to behavior). Social support and competing demands were not associated with self-efficacy. Conclusions Consistent with Social Cognitive Theory, results suggest that self-efficacy is behavior specific and each measure likely provides unique information. Practice implications Interventions should be tailored to address specific self-efficacy types.

Relation between neighborhood median housing value and hypertension risk among black women in the United States.

We examined the relation between median housing value and hypertension risk among US Black women. We gathered data from the Black Women's Health Study, a prospective follow-up of 59000 Black women aged 21 to 69 years in 1995. Median housing value from US census data was used to measure neighborhood socioeconomic status. Cases of hypertension were identified through postal questionnaires mailed in 1997, 1999, and 2001. Clustered survival regression models were used to estimate incidence rate ratios. During 180294 person-years of observation, 3780 cases of hypertension were reported. A significant inverse, graded association was found between median housing value and hypertension. The incidence rate ratio for women living in low median housing value neighborhoods relative to high was 1.29 (95% confidence interval=1.14, 1.45) after adjustment for individual risk factors. The association was evident even at higher individual levels of income and education. Median housing value is inversely associated with hypertension in Black women, independent of individual risk factors. Lowering hypertension risk in Black women will require a greater understanding of the underlying social inequalities that adversely affect health.