Hypertension problematic in Harlem
By Lauren Kirchner
September 20, 2009
About a dozen senior citizens sat in a circle of chairs at a senior center in West Harlem, leaned back, and laughed for five minutes straight. This “laughter meditation,” as their yoga instructor Badra Om, calls it, usually starts with Om herself letting out a loud, high-pitched cackle. The huge sound coming from such a petite woman is surprising, and the laughter is infectious. Soon the whole class joins in: first tentatively, then with feeling.
Om, who visits the Hamilton Grange Senior Center each Tuesday to teach the free class from 11 to noon, teaches that laughter is one small part of a holistic approach to relieving stress, which helps to fend off a range of preventative health problems in the neighborhood. “You don’t need a joke to laugh,” she said in an interview after her class last week. “Laugh heartily for 15 minutes and you’ll burn 50 calories.” Laughter, however, isn’t enough to prevent ailments like hypertension and heart disease; she also tells her students to exercise regularly, eat healthy food, and take their vitamins.
Hypertension – defined by a blood pressure reading of 140/90 or higher – affects the Harlem community in much greater numbers than New York City as a whole. According to a Community Health Profile by the New York City Department of Health and Mental Hygiene, one in four New Yorkers have been diagnosed with and treated for hypertension, but in Harlem, one in three people suffer from it. The risk increases with age as well. About half of Harlem’s population 45 to 64 years old have high blood pressure, and two-thirds of people 65 and older have it. If left untreated, hypertension can quickly lead to heart disease, stroke, and in the worst cases, premature death.
The causes of hypertension are complex, and include poor nutrition, lack of physical activity, and stress. Amy Crumly, a social worker at the Charles B. Rangel Community Health Center of New York-Presbyterian Hospital, said in an interview in her office that these risk factors exist disproportionally in the Harlem community, especially among the Hispanic population. The Department of Health found in a 2004 study that 48 percent of Harlem residents don’t exercise at all, compared to 32 percent of people in Manhattan overall. Crumly estimated that two out of three of her patients are obese are overweight. Obesity leads directly to hypertension problems. Crumly often counsels patients who are planning on undergoing gastric bypass surgery to combat extreme cases of hypertension and diabetes caused by obesity. This increasingly common surgery is now covered by Medicaid, which most of her patients use. Crumly blamed inactivity and starchy diets for Harlem’s obesity epidemic. “Latinos are actually living shorter lifespans in America than in their home countries like the Dominican Republic,” she said. “Snacking and overeating is very much a part of our culture in America.” Crumly added that rice, beans and fried fast foods are so cheap in New York City that some people don’t make enough of an effort to seek out more healthier, and often more expensive, food options.
Crumly added two more contributing factors to obesity that may be less obvious. Foreign-born Hispanic women are less likely to breast feed their newborns in America than in their home countries because the WIC program – a federal voucher program for women, infants and children – gives them formula for free. Crumly explained that women perceive formula as healthier than breast milk, but that not breast-feeding a child actually raises its risk for obesity in their childhood and teen years. And although many food pantries in the area cater to local hungry families, those families that depend on food pantries for their main source of nutrition will tend to be at a risk for hypertension because most of the food provided by pantries is canned, and therefore high in sodium.
Carly Hutchinson, the communications specialist at the Harlem Health Promotions Center, also emphasized the importance of access to preventative care in keeping hypertension low. According to the 2006 Community Health Profiles study by the New York City Department of Health and Mental Hygiene, people living in West and Central Harlem are much less likely to visit a healthcare provider for regular checkups than New Yorkers overall. It’s not just about poverty, Hutchinson explained: “Some of the factors that are problematic in Harlem are cultural. Some people are not educated as to the importance of preventative care. Or, they don’t seek care because they don’t realize that screenings are free. So they are very rarely getting screened until they get to a place where they can’t be treated.” That place, Hutchinson said, is a heart attack, or cardiac arrest.
Of the factors contributing to hypertension, stress is the most elusive and difficult to measure. Dr. Joseph Schwartz, a faculty member at the Center for Behavioral Cardiovascular Health at the Columbia University Medical Center, has spent much of his career trying to do just that. When someone feels stress, he explained in an interview in his office last week, the body is flooded with adrenaline, the heart rate rises, and then the adrenaline subsides and the heart rate falls. Another chemical, cortisol, works more slowly than adrenaline but also lasts longer. Chronic stress, the act of continually flooding your arteries with cortisol, actually stiffens the arteries. “If you repeatedly stress an organ, you will permanently raise its blood pressure, and actually do permanent damage,” Schwartz said. “Chronic or repeated stress factors can damage the arteries and wear out the body.” Schwartz said that socioeconomic stresses in poverty-stricken areas of Harlem would logically contribute to high rates of hypertension in the community.
The good news about hypertension is that it is not a predetermined fate. “It’s noteworthy that for all the research that’s been done, we have been unable to identify a ‘hypertension gene,’ so genetics per se is not an overwhelming factor in determining risk,” Dr. Schwartz said. Hypertension is also reversible if caught at the right time, which is why organizations like New York-Presbyterian, the HHPC and Columbia Medical Center are working hard to educate the community about healthy living and – in the case of Badra Om – healthy laughing.
