High blood pressure, heart disease and more with Rachel Villanueva, MD

Introduction to the Podcast and Guest
[00:00] Hello, this is the American Medical Association's Moving Medicine video and podcast. Today we're joined by Dr. Rachel Villanueva, president of the National Medical Association and a clinical assistant professor of obstetrics and gynecology at the New York University Grossman School of Medicine in New York, and she'll be

[00:20] discussing ways to reduce hypertension and improve health outcomes in black communities. I'm Todd Unger, AMA's Chief Experience Officer in Chicago. Thank you so much for joining us, Dr. Villanueva. May 17th was World Hypertension Day, which serves as an opportunity to recognize and address how hypertension

[00:40] disproportionately affects black communities, in particular women. I'm going to say when I first saw this statistic, I thought it had to be wrong. That more than 50% of black women over the age of 20 have high blood pressure and nearly 50% of black women over the age of 20 have heart disease

Factors Contributing to Hypertension in Black Communities

[01:00] Those are startling. What are the factors that you see that underline numbers like those? Thank you so much for having me on today. I think it's such an important topic to discuss. And those numbers are startling. And it's startling for the black community in general. We have to underscore that.

[01:20] that first of all, both men and women are disproportionately impacted. And I think many of the same reasons we saw COVID disproportionately impacting the black community, the same reason type retention. So that would be the social determinants of health, where people live, work, play, whether they have access to quality health

[01:40] health care, nutritious foods, healthy green spaces to exercise, also structural and systemic issues. Our health care system unfortunately is not the most equitable system and so there are people who face challenges and in our community there is

[02:00] bias and racism against people of color in the healthcare system who receive quite frankly just different care and substandard care. So all of those things factor into the disproportionate impact in our community. Now one thing, and it just may be my own personal experience, but I think of high blood

Early Onset Hypertension and Lifestyle Factors

[02:20] blood pressure is kicking in a little bit later in life, 20 seems pretty young. Is that unusual? It's not unusual. We're actually seeing younger and younger individuals, even some in the pediatric age range with hypertension, and it's really based on their access

[02:40] to nutritious foods? Are they having more processed foods that are high in sodium? Are they exercising? There are a lot of schools that have even eliminated just regular PE, regular physical exercise for students. And really, kids are at the computer more nowadays. I mean, we all are even during the pandemic. So all of these things

[03:00] really contribute to the fact that we are seeing younger and younger individuals impacted. Now I know this because I've seen other work that the AMA has been involved with on the blood pressure point, but another surprising thing to most people is just how many people are completely unaware of the fact that they have high blood pressure

[03:20] And how do we end that kind of lack of awareness and make it more visible to folks? Well, I think what we're doing today is just highlighting how what the numbers are. I think when people hear the numbers of 50 percent of women over the age of 20, black women over the age of 20, I think most

Lack of Awareness and the Importance of Education

[03:40] Most women in their 20s don't even think they're at risk for high blood pressure. So really just educating, I think awareness is so important and highlighting these numbers and making this conversation commonplace and common knowledge I think is important. A big effort that's underway right now that you're

[04:00] personally involved with is called Release the Pressure and that's a collaborative effort between the AMA and other healthcare organizations, including the NMA. And its goal is to make sure that black women are aware of and doing something to support their heart health. When you start

[04:20] off by just telling a little bit about why you got involved in this initiative. Well, I think, again, awareness is so important, education is so important, highlighting the statistics that many are unaware of. So as president of the National Medical Association, which was founded

[04:40] In 1895 to promote black health to make sure that our community had equitable health care. It just perfectly aligns with the mission of our organization. I think it's also so important and we know how important it is for individuals of color to see representation in the people that take care of them.

The ‘Release the Pressure’ Initiative

[05:00] We know that impacts how well their health outcomes are how well they'll do, how well they'll adhere to treatment plans, and their overall patient experience so and it may being part of this coalition is is is is one of our priorities. Personally, as an OBGYN.

[05:20] know that the black maternal mortality rate is three times that of white women in the United States and we know that black women are disproportionately dying of hypertensive disorders in pregnancy. So for me it's a way to actually be proactive and impact the patients that I see and impact maternal health outcomes. One of the things that you talked about earlier

[05:40] earlier in terms of this disparity and a lot of factors contributing to this. One is clearly around access to care. What role do you see that playing in this hypertension crisis and what can we do to address that? I think we know that access to

[06:00] And I think that's across the board for any any disease that we're talking about, whether it's hypertension or COVID. We know that access to quality care is so important. And we just need to continue to advocate for the fact that health care is a human right. I think we we.

Black Maternal Mortality and Hypertension

[06:20] As physicians, we know that we have to be able to have patients have access to us to be able to take care of them. And we need to ensure that we have people that are insured, that they have quality hospitals that they can go to in their neighborhoods, but also addressing those

[06:40] social determinants of health that also so greatly impact someone's health and ability to live a healthy and well life, and also addressing issues of our workforce and whether it is shortages of providers in urban and rural communities, and also the diversity of our workforce, making sure

[07:00] reflects the people that we're taking care of. Now historically there have also been barriers that prevent women from you know being self-advocates in their health care. Talk a little bit about what you see as some of those top barriers and how all the physicians out there can create the kind of

[07:20] of space for dialogue in their exam rooms to address that. Yeah, I think it's so important for us to remember that patients come to us to get care. And so we need to be sensitive to them both culturally and their lived experiences and for physicians to understand that not everybody

Barriers to Healthcare Access and Equity

[07:40] comes from the same background. I think it's also important to understand again that we have an inequitable healthcare system and that some people have faced discrimination and bias in the healthcare system, have a mistrust of the healthcare system based on how they were either treated or the historical

[08:00] knowledge of experimentation on their community. All these things really factor into whether someone will trust what you're saying, or will even come in to get care at all. So I think we as a healthcare community need to do a better job of instilling that trust in the black community.

[08:20] and continuing to advocate for equitable care for them. When you're having a conversation or when a physician is having a conversation about hypertension with a patient, what do you want to make sure that they hear from you? I think first is for them to understand what their

[08:40] personal risk factors are and how important prevention is because once you have hypertension and once it's causing damage to other organs where we've already we've lost half of the battle. So it's really understanding those modifiable risk factors and really understanding those statistics about how

Physicians’ Role in Addressing Health Disparities

[09:00] cardiovascular disease is the number one killer of black women. I think most women are more concerned about cancer than they are about cardiovascular disease. And understanding that hypertension does not necessarily make you feel bad to be causing damage, to be causing issues with your vision, kidneys.

[09:20] disease and other chronic diseases. And especially for pregnant people who are thinking about becoming pregnant, I also want them to understand how much this can impact their ability to have a safe and healthy pregnancy. So prevention is really an important part of the conversation.

[09:40] conversation that I have with all the patients that come through my office. I think there's one more surprising thing that there are also links between mental health and heart disease. Obviously a big impact then you would expect coming out of something like a pandemic. Tell us a little bit more about that connection.

[10:00] I mean, definitely the mind-body connection is very strong. And I think we as a healthcare community probably have underestimated that in the past. And we're really realizing how much that stress, anxiety, depression can impact or stress hormones can impact high blood pressure, can impact

Mental Health and Hypertension Connection

[10:20] In fact, even premature aging and black women concept that they call weathering that your social and economic and just the factors in your the stresses in your life can cause you to prematurely age and predispose you to chronic diseases. So really understanding that that's, that's a

[10:40] Not a large part, but a part of the Release the Pressure campaign is mental health, self care, and understanding how important those things are to keeping you physically healthy as well. Dr. Villanueva, thank you so much for being here today and sharing this important information and your perspective for physicians.

[11:00] looking for more information on the AMAs Release the Pressure campaign, you can visit releasethepressure.org. We'll be back soon with another moving medicine video and podcast. You can find all our videos and podcasts at ama-assn.org. Thanks for joining us. Please take care.

Conclusion and Resources

[11:20] you