Considerations of Health Equity in Neurocritical Care: Healthcare Disparities in Hypertension, Stroke and Hypertensive Disorders of Pregnancy

Abstract Purpose of Review In the United States (US), hypertension is more prevalent among certain ethnic and racial groups including: Black-African Americans (BAA), Hispanics, American Indian and Alaska Native (AI/AN) and Asian and Pacific Islander (API); these populations also experience higher hypertension- and stroke-related mortality rates among both non-pregnant and pregnant adults compared to non-Hispanic White (NHW) Americans. The causes for the increased prevalence and higher case-fatality rate are unclear; however, social determinants of health (SDoH) and systemic racism likely play significant roles. Recent Findings While genetic factors may contribute to hypertension, no definitive genetic variations have been identified. Candidate traits show only inconclusive links to the disproportionate burden of hypertension among BAA. Socio-economic factors, environmental factors, and other SDoH likely drive the observed higher rates of hypertension and stroke morbidity in BAA and other ethnic groups. Hypertensive disorders are a leading cause of maternal mortality disproportinately affecting BAA women. Studies estimate that up to one-third of disparities in hypertension management in the US can be attributed to SDoH. Healthcare disparities in obstetric patients with stroke are similar to those among non-childbearing adults; however, notable differences include access to prenatal care and parental factors. Despite advances in medical treatments, improved patient education and substantial healthcare spending, maternal mortality and morbidity rates have risen in recent years. The impact of the disparities, in the case of obstetric patients, may also affect fetal development and subsequent neonatal and pediatric health. Summary Racial and ethnic minorities in the US, namely BAA and Hispanics, AI/AN and API, continue to experience disparities in the incidence, prevalence, and treatment of hypertension and stroke. Factors such as socioeconomic status, structural racism and healthcare access affect hypertension prevalence and outcomes, as may noise pollution, sleep hygiene, air quality and other environmental factors. In pregnant women, these disparities have a negative impact on mortality rates and stroke risk. Despite ongoing research, racial and ethnic minorities remain underrepresented in clinical studies, underscoring the need for more inclusive research to improve hypertension management in diverse populations.