Hypertension Before 40 Linked to Doubling of Stroke Risk in Black Women

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Study presented at ISC 2024 suggests Black women with hypertension before age 35 face a 3-fold increase in risk of stroke while hypertension before 45 linked to doubling in stroke risk.

Results of a recent study suggest Black women with treatment-resistant hypertension prior to turning 35 years of age were at a 3 times greater risk of having a stroke compared to their counterparts with no history of hypertension.

Presented at the American Stroke Association’s International Stroke Conference (ISC) 2024, the analysis of the Black Women’s Health Study also suggested women with hypertension prior to turning 45 years of age had a more than doubling in risk of stroke after adjustment for additional risk factors, such as age, neighborhood socioeconomic status, residence in Stroke Belt, and other lifestyle factors.1

“This research was motivated by the glaring disparity I have seen in my own practice. Strokes are occurring at younger ages among my patients who identify as Black and among women,” said study investigator Hugo J. Aparicio, MD, MPH, an associate professor of neurology at Boston University Chobanian and Avedisian School of Medicine.2 “Early onset stroke, particularly at midlife, is even more tragic because these patients often have families or are caretakers for sick family members.”

Launched in 1995, the Black Women’s Health Study is a prospective study of Black women from across the US with the intent of providing the healthcare community with further insight into the care of Black women. As part of the study, women were administered biennial questionnaires assessing information related to reproductive health, lifestyle, medication use, finances, mental health, demographics, family history and psychosocial factors.1,3

With previous research elucidating the suboptimal care for women of color in the US, Aparicio and a team of colleagues from Boston University sought to assess how age development of hypertension might influence stroke risk among Black women later in life. Among the 59,000 women included in the study, investigators identified 46,754 women with no history of stroke and younger than 65 years of age when completing the 1999 questionnaire. This cohort had a mean age of 42.6 (Standard Deviation [SD], 9.6; range, 26-64) years and the mean follow-up was 17.1 (SD, 5.0) years.1

Investigators compared participants with and without hypertension prior to turning 45, between 45-64 years of age, and within 10-year are intervals from 1999 to 2019 using Cox models. For the purpose of analysis, a history of hypertension was defined as physician diagnosed hypertension with use of an antihypertensive medication or diuretic or use of an antihypertensive alone.1

Initial analysis revealed 2980 (10.5%) had hypertension at baseline and a stroke event occurred among 1485 (3.2%) of participants during the follow-up period.1

Further analysis suggested Black women with hypertension before the age of 45 had a greater risk of midlife stroke (Hazard Ratio [HR], 2.23; 95% Confidence Interval] 1.79-2.78) after adjustment for age, neighborhood socioeconomic status, residence in Stroke Belt, smoking, body mass index, and diabetes. Investigators also pointed out an apparent increase in risk was observed for women with hypertension at midlife age 45 to 64 (HR, 1.69; 95% CI, 1.47-1.95) and was greatest among those with hypertension between 24 to 34 years of age (HR, 3.15; 95% CI, 1.92-5.16).1

“We expected to see an association between having high blood pressure at a younger age and having a stroke during midlife and later life, however, we were surprised and concerned to see the magnitude of the relationship, especially for women who were taking antihypertension medications before age 35,” Aparicio said.­­­­2


  1. Aparcicio HJ, Lioutas V, Shulman JG, et al. Early Onset Hypertension Increases Risk Of Midlife Stroke Among Black Women. Paper presented at: International Stroke Conference 2024; February 7 - 9; Phoenix, AZ. Accessed February 2, 2023.
  2. American Heart Association. Black women with high blood pressure before age 35 may have triple the risk of a stroke. American Heart Association Newsroom. February 1, 2024. Accessed February 2, 2024.