Director John Singleton’s Fatal Stroke Spotlights Black Americans’ Hypertension Risk

Filmmaker John Singleton was hailed for his ability to portray black Americans’ lives on screen. His death drew attention to one of the biggest threats posed to those lives.

Singleton, who was nominated for an Oscar for directing “Boyz N the Hood”, suffered a stroke April 17 and died Monday after being taken off life support. He was 51. In a statement, his family said he had “quietly struggled with hypertension“.

Cause of adult disability

Hypertension, or high blood pressure, is often called the “silent killer” because it has no obvious symptoms. It’s the top risk factor for stroke – the No. 5 cause of death in the US and an especially dangerous problem for black people.

Black men are twice as likely to have a stroke as their white adult counterparts and are nearly 60% more likely to die from a stroke than their white peers, according to the Centers for Disease Control and Prevention. Beyond being a leading cause of death, stroke is a leading cause of adult disability.

“And the part that is not mentioned as much is that it’s a leading cause of cognitive dysfunction as well. And depression,” said Dr Bruce Ovbiagele, professor of neurology and associate dean at the University of California, San Francisco.

Although stroke mortality has fallen by 80% over the past 60 years, there has been no significant decrease in the disparity between white and black people.

High blood pressure might help explain some of that gap. The prevalence of high blood pressure among African Americans is among the highest in the world. More than half of black adults in the US have high blood pressure.

Other risk factors for stroke include diabetes and obesity, which affect African Americans at higher rates, as well as smoking, which researchers say doubles the risk of stroke in African Americans. Sickle cell anaemia is also a factor; it’s the most common genetic disorder among African Americans.

More likely to live in poverty

A 2017 report in the journal Circulation spelled out many additional possible influences, ranging from cultural attitudes toward exercise; the unhealthy parts of the traditional Southern diet, which is high in added fats, sugars and sodium; and the health issues that come from stress and perceived discrimination.

Black Americans are also more likely to live in poverty, statistics show. And that’s another factor, said Dr Clyde Yancy, a professor of medicine and chief of cardiology at Northwestern University.

“In the diet that people eat, which is all they can afford – one especially represented by fast foods and high sodium intake – the risk of high blood pressure is exaggerated and the onset is much earlier in life,” Yancy said.

But scientists do not fully understand the risk gap, Ovbiagele said. Up to 30% of the reasons behind the increased risk for black Americans is a mystery, he estimated.

“Is it genetic? Is it an interaction between the genes and the environment?” Some research suggests lingering psychosocial effects from slavery could be factors, he said.

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