"We ate fried chicken every week when I was growing up. We were eating processed foods. It's so different now."
-- Temisha Sledge
Temisha Sledge was a teenager when she first learned she had high blood pressure. Now 40, the McKees Rocks mom hopes to share some wisdom from her life's health challenges with her two daughters, ages 14 and 7. As an African-American woman, she knows she has a higher chance of having hypertension than some other population groups. Whether it is risk associated with heredity or habit, she also knows firsthand something can be done about it.
Her blood pressure was above normal when Ms. Sledge went for a physical before college and her doctor told her she would have to keep track of her numbers.
"I was about 18, 19. I remember the doctor said it was going to be that way. ... I know I had a family history of it," she said. She was told to watch her diet, and she was put on medication during her college years.
Known as "the silent killer," high blood pressure, also known as hypertension, ended 61,762 U.S. lives in 2009, and more than 20 percent of those killed were black -- well above their proportion of the population. It's called silent because it rarely shows any symptoms. It occurs when the pressure of the blood against the artery walls is too high.
Untreated, hypertension causes a series of complications such as heart attack, heart failure, stroke, chronic kidney disease and aneurysm (an abnormal bulge in a blood vessel).
According to the American Heart Association, high blood pressure affects one of every three adults in the nation, and, of those 77.9 million Americans, nearly 20 percent are unaware they have it.
The association also says that non-Hispanic black Americans experience hypertension nearly 10 percent more frequently than non-Hispanic whites.
Indu Poornima, a cardiologist at Allegheny General Hospital, believes that these statistics are related.
"We don't have clear answers on why, but we know that genetically [black Americans] are at a higher risk," she said before suggesting "underdiagnosis and undertreatment" are also potential reasons for the health disparity.
Ms. Sledge, who is one of Dr. Poornima's patients, said taking medication seemed to improve her blood pressure numbers in college.
"I remember being taken off medication; it was controlled well," Ms. Sledge said. "I was more active, watching what I was eating. The cholesterol was always checked and that was fine."
But in time, the high blood pressure returned. She experienced a gradual weight gain over the years.
"I was going back and forth on diets. ... My blood pressure fluctuated with weight gains and weight losses. I always thought it was the eating habits of the family, traditionally the things that we ate" that caused the weight gain and hypertension.
"We grew up eating foods that now you're supposed to avoid," Ms. Sledge said. "They're high in sodium -- it's soul food -- [and] meals were prepared a certain way. Now I'm not sure if it's all the food [that's to blame] or there is a genetic disposition for having weight issues, blood pressure problems.
"My mother had high blood pressure when I was growing up, but when I got older it just went away" in her mother. "My brother was always healthy." None has diabetes, she said.
When she was pregnant with her first child, she said, her blood pressure fluctuated. "I had some preeclampsia from that point on, was on blood pressure medication from then forward." Preeclampsia is high blood pressure and excess protein in the urine of a pregnant woman, which can lead to serious complications in the mother and the baby if it goes untreated.
From that point on, she said she's been on medication and her blood pressure numbers are good, even with weight fluctuations. "It's usually 118 over 65, 118 over 70," she said, which is under the normal ceiling of 120 over 80.
Dealing with other chronic illnesses, however, recently led her to take early retirement from a 15-year career in social work. She has some kidney damage that her doctor told her was probably caused by the blood pressure and weight fluctuations. And this year she learned she has lupus, an autoimmune disease. Now she has a string of doctors to see, including Dr. Poornima, along with a nephrologist, rheumatologist and ophthalmologist.
"I try to stay on top of it. Hopefully I can get off some of these medications," she said, adding that she plans to add pool exercises to her routine to keep physically fit.
Dr. Poornima and the West Penn Allegheny Health System have begun a study to find out why hypertension and its complications are more prevalent in black Americans than in other U.S. racial groups.
"African-Americans in Allegheny County have higher death rates from heart disease than those in the rest of the state and other ethnic groups," said Dr. Poornima, in a press release announcing the study.
Funded by a grant from The Pittsburgh Foundation, the study will look at modifiable risk factors, including abnormal lipids (such as cholesterol), smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, lack of regular physical activity and consumption of fruits, vegetables and alcohol in 250 black Americans between the ages of 40 and 70.
Many of these risk factors also contribute to hypertension and can be adjusted to help maintain heart health or to treat or prevent high blood pressure. Medications and behavior changes can help.
Dr. Poornima suggests that people consult The American Heart Association's "Life's Simple 7" (http://mylifecheck.heart.org) for prevention and treatment options. The association suggests that people:
1. Get active
2. Control cholesterol
3. Eat better
4. Manage blood pressure
5. Lose weight
6. Reduce blood sugar
7. Stop smoking.
Although it has no symptoms, physicians can determine if a patient has hypertension by using a sphygmomanometer, a cuff that goes around an arm with an attached pump and gauge to determine a patient's blood pressure.
A patient is classified as having "prehypertension" if blood pressure is between 120/80 and 140/90 and hypertension if it's above that.
"They have to actually physically go and have their blood pressure checked at their pharmacy or their primary care doctor," Dr. Poornima said. "Compliance with therapy once they get on medication is very important."
Ms. Sledge said she wants to share what she's learned with her daughters and others.
"I write to my daughters all the time; I write that they need to take care of their bodies. ... I don't want them to get to my age and to be the way I am; they can prevent it."
"There's more to be said about prevention ... nobody told me that. I was doing what my mother did. ... I'm only 40, I want to break the cycle."
Her advice to her daughters: "There's nothing wrong with being healthy, watching what you eat, everything in moderation. ... You don't have to be obsessive about it."
She added, "I just want them to get into a comfortable place themselves, so they don't have to take medications."
Ms. Sledge is doing her part adapting soul food recipes. Her collard and kale greens, which used to be cooked with salted fatty ham parts, now get a lighter treatment.
"If you do a boneless chicken thigh, cook it until it makes its own broth. Put the kale in the pan and put a lid on it, and it will sweat it down."
"They'll eat it still, as long as you put in the garlic and the onion. They'll eat it as long as it tastes good. ... They laugh about it, but they eat it."