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Confronting “The Silent Killer”

Hypertension brings the issue of health disparities into focus. It is a major public health problem for blacks who live in the United States, and the rate of prescribed medication adherence is significantly lower in blacks than in whites.

Blacks in the U.S. are more likely to have high blood pressure than any other group, and they have striking co-morbidities largely because they do not adhere to their medication. Blacks with high blood pressure are at an 80 percent greater risk of stroke and a vast 420 percent greater risk of kidney disease compared with whites. 

“You have treatment available and a graveness of disease and common knowledge, even in the black community, about ‘the silent killer’ of hypertension, yet the poor outcomes continue,” said Dr. Lewis.

To address this, Dr. Lewis created a church-based hypertension intervention, funded by the Edna G.Kynett Memorial Foundation.

Dr. Lisa Lewis conducts community-based hypertension research with congregants of Philadelphia's historic Mother Bethel Church.Dr. Lisa Lewis conducts community-based hypertension research with congregants of Philadelphia's historic Mother Bethel Church.


For many Sundays before services, Dr. Lewis visited Mother Bethel African Methodist Episcopal Church in downtown Philadelphia to take congregants’ blood pressure and monitor their medication adherence. Over coffee and conversation in the meeting room of the historic church, congregants met with “Dr.Lisa” in a familiar, relaxed setting among their peers.

“Community sites are key to moving toward health equity,” said Dr. Lewis. “Institutions like churches are comfortable mainstays in people’s lives, with trust among the leadership and the members. IF Pastor said it’s okay to bring this program here or to go see Dr. Lewis to have your blood pressure checked, they’ll do it.” 

But why black people people don’t seek out or adhere to treatment and why black patients don’t get proper treatment are two different things, explained Dr. Lewis. America’s history of slavery, racism, and discrimination, and the horrors of research misconduct using a rural black population in the Tuskegee syphilis experiment have deeply sown mistrust of the healthcare establishment among black Americans. 

In this shadow are other factors precluding black Americans from seeking or adhering to treatment, said Dr. Lewis. These include false health beliefs or poor knowledge about symptoms, disease, and the consequences that can occur without proper treatment; cultural beliefs; limited access to healthcare providers and long waits for clinic appointments; and key demographic factors, such as low-income status. 

High Blood Pressure and African Americans