High blood pressure is climbing in young adults. In Mississippi, young women face the rising stakes

By Anna Hu | Originally published by Mississippi Today

For months, Katie Shappley was in denial about her symptoms. Despite difficulty breathing and odd tingles in her left arm, the daughter of a “hard-headed farmer man” didn’t go see a doctor until her headaches were bad enough to call off of work. 

When she finally went in, Shappley, who works in physician credentialing at the Baptist Memorial Hospital in Columbus, remembers the nurse practitioner being alarmed by her blood pressure reading. It was well above the normal range, which should be less than 120 over 80 mm Hg.

Shappley didn’t think she could have high blood pressure, which had shown up in her older family members in their 50s and 60s. She ate healthy, had given birth to her second son and ran around after two young kids. She was only 30 years old. And she’s not the only one. 

In recent months, a spate of studies have highlighted increasing rates of high blood pressure in younger people, with people living in the South and who identify as Black at greater risk. Mississippi already leads the nation in rates of high blood pressure, a leading contributor to maternal deaths and a growing concern for young women.

In March, researchers from the University of New Mexico presented findings at the American Cardiology Conference showing that deaths related to high blood pressure increased fourfold for young women in the last two decades. Mortality rates were higher for women in the South relative to the rest of the United States, and for Black women relative to women of other racial groups. On July 3, a team at Northwestern University published their study that analyzed disparities in high blood pressure between Black and white first-time mothers. 

“Hypertension is a silent killer, and it’s called that for a reason,” said Sandra Melvin, executive director of the Ridgeland-based Institute for the Advancement of Minority Health. 

People who have high blood pressure, also known as hypertension, might not realize why they’re feeling more tired than normal, getting headaches, feeling pain or swelling in their extremities or experiencing blurry vision. Even those symptoms might not show up for the first year while blood vessels are already being damaged, she explained. 

“People get used to working when they feel tired,” Melvin said. 

Blood pressure education

Dr. Barry Bertolet is one of Shappley’s doctors and a Tupelo-based cardiologist who has been practicing for over 30 years. Recently, he has seen an increase in younger patients with high blood pressure.

He tells patients to consistently check their blood pressure numbers. Two numbers make up these readings. The top number, the systolic pressure, measures the pressure of blood against arteries when your heart is active and pumping. The bottom one is called diastolic pressure, measured when your heart is resting between beats.

Anything 120 over 80 mmHg is an elevated blood pressure, he explained. Readings above 130 over 80 mmHg is stage one high blood pressure, and above 140 over 90 mmHg is where he would recommend getting started on medication. 

As blood pressure increases, it can impact blood vessels in several ways, Bertolet explained. The innermost layer of a blood vessel is only one cell thick. When the heart is pumping blood too fast, it can damage those cells. If the body senses an injury, it will send repair materials to the site – but their presence narrows the channel, potentially making matters worse. 

The force of the blood can also damage the connection points between blood vessels, when they branch off of one another. These repeated strains build up over time, harming the heart, brain and kidneys and leading to increased risk of strokes, heart failure and dementia. 

“If people were to put their dime on something that’s going to make the biggest impact, because it does affect a multitude of systems across the body, this has a big bang for its buck,” he said. 

With the University of New Mexico study, where young adults were defined as people from the ages of 25 to 44, researchers found that Mississippi led states in the 90th percentile for high blood pressure-related mortality, Bertolet told Mississippi Today. 

“We’re the worst state for young women having hypertension and then dying of that hypertension,” Bertolet said.

Health experts recommended that people follow these steps to maintain healthy blood pressure:

• Focus on lean meats, fruits and vegetables, and reduce salt
• Increase movement — it can be as simple as walking 
• Reduce amount of alcohol intake and smoking
• Reduce stimulants, including excessive caffeine and drugs such as adderall 
• Check blood pressure at least annually, and monitor at home with a blood pressure cuff, if necessary 

High blood pressure after pregnancy

At 30, Canton office manager Natasha Keys was confronting high blood pressure for the first time. She was pregnant with her son, Cedarian. She calls her son her “miracle baby” because her pregnancy was so fraught. 

Keys had never had blood pressure problems before, she said, but once she got pregnant, she saw a shift. In her third trimester, the numbers “skyrocketed,” she said. High blood pressure changed the trajectory of her pregnancy, and forced her into decisions that she didn’t want to make. 

At times her systolic blood pressure, the top number, reached into the 300s. A number that high is dangerous and very rare, Bertolet said, while the 200 range is more common for women experiencing preeclampsia or or eclampsia. Key’s baby needed to come out early, but she said healthcare providers told her natural methods, which Keys had wanted, weren’t going to work. 

“Everything that I didn’t want, I had to get,” she said. “I got the epidural. I ended up having a C-section.”

Keys remembers being in the hospital, her mother sitting beside her, and being afraid that she wouldn’t survive the pregnancy. 

“I’m saying to myself, ‘Am I gonna make it? Am I going to see my son?,’” Keys said.

Through the difficult journey, Keys leaned on her support network, including her mother and the doula she connected with through Magnolia Medical Foundation, Kashuna Watts. 

Watts has been a practicing doula for almost 13 years and has seen an increase in young clients with high blood pressure, including ones as young as 15 and 24 years old. She started training to be a doula after one of her best friends died a day after giving birth from postpartum preeclampsia, a life-threatening condition related to high blood pressure. Now, she provides educational support for new mothers and specializes in high risk pregnancies like Keys’. 

“Natasha never experienced hypertension before pregnancy,” Watts said. “So, they don’t realize that it’s a thing. Even if you have no history of hypertension or preeclampsia, it still can happen to you.”

She wants new moms to know that postpartum preeclampsia can happen up to three months after giving birth, and advocates for them to know what their own “normal” is. If you’re seeing a spike, especially if it’s 20 points higher than baseline, it’s time to speak up, she said. 

Landscape for treatment options evolves

Treatments for high blood pressure are better tolerated than they were a few decades ago, said Keith C. Ferdinand, a heart specialist and professor of medicine at Tulane University. 

For people looking to manage their blood pressure, Ferdinand recommends engaging in lifestyle changes first, then following up with medication, if needed. He likes the DASH diet, which emphasizes lean meats and fruits and vegetables high in potassium, which can help lower blood pressure. He acknowledged these foods can be more expensive, and pointed to frozen vegetables as a budget-friendly alternative to fresh ones. 

“Blood pressure begets blood pressure,” he said, encouraging young people with normal blood pressure to get it checked once a year. “It doesn’t stay. It rises.”

Ferdinand, who is from New Orleans, isn’t surprised that studies have found an increase in high blood pressure and associated mortality, with a bigger jump in the South. He pointed to factors like the “Southern Diet,” which tends to be high in sodium and fried foods. He also said young people may be unaware of their blood pressure numbers.

Another study identified marker of uncontrolled blood pressure is not having a regular source of medical care, Ferdinand said. With insurance costs rising and Medicaid becoming more inaccessible, it will be harder for people to maintain consistent care. Meanwhile, reductions in social safety net programs, including the Supplemental Nutrition Assistance Program, or SNAP, will make it harder for families to purchase healthy foods, he said. 

Melvin also pointed to the systemic barriers facing communities with fewer green spaces where they can exercise, or who live in food deserts where fresh produce may require reliable access to transportation to reach. 

Outside of lifestyle changes, common methods of managing high blood pressure focus on medications, which can vary by stage of the condition. While many of these strategies are still effective, Bertolet said few new medications have emerged in the past two decades.

Two and a half years ago, Shappley underwent a relatively new procedure called renal denervation, which uses sound or radio waves to destroy kidney nerves that increase blood pressure. Bertolet introduced it to her, explaining that it can help people with high blood pressure resistant to medication, which Shappley had. 

For her it was transformative, and allowed her to bring her blood pressure down to the normal range. She’s now nearing 40 and is finding that her medication can keep her blood pressure under control when previously it couldn’t. 

Shappley now recognizes that she was being stubborn and said she should have gone for treatment earlier — if not for herself, then for her family. 

“If you ignore it and you don’t accept it, then you won’t be around for the people that love you,” she said.

She knows intimately how this can happen. Shappley said her father didn’t take his medication consistently after suffering a heart attack and undergoing open heart surgery. He started fainting, but only went to seek medical help after a faint-induced fall hurt his arm. By then, it was too late for doctors to address the blood clot that had formed in his heart, and he died at the age of 60. 

“My dad ignored his problem, and now I don’t have him,” Shappley said. 

Living with high blood pressure

Since giving birth almost a year ago, Keys has made lifestyle changes including watching her diet, and she still takes medications to address her blood pressure. Life has moved on, she’s taking classes in information technology and business administration, working, taking care of her young child. 

But she still gets emotional when recalling on the challenges of her pregnancy. 

“I try to tell everybody, ‘Hey, having high blood pressure isn’t a joke,’” said Keys, who is watching a friend enter her pregnancy with elevated blood pressure. “Having those high numbers, it just was scary.”

With summer rolling in, doctors have warned Keys that heat can be dangerous for her blood pressure and her thyroid disease. She doesn’t spend much time outdoors during the day. 

She’ll be making an exception soon, though. For Cedarian’s first birthday, she wants to take him to the water park to splash around and spend time together as mother and miracle son.

This story was produced with support from the Sarah Yelena Haselhorst Fund for Health Journalism.

This article was originally published by Mississippi Today and is republished here under a Creative Commons license.

Source: Original Article