michigan hypertension core curriculum - State of Michigan

syndrome may have additional quality of life limitations from their weight itself. The increased
cardiovascular risk found in this population highlights the negative consequences of even small
amounts of weight gain. Untreated, a number of individuals’ metabolic syndrome or just frank obesity
will progress to frank diabetes mellitus, develop hypertension, and increasingly manifest dyslipidemias
such as high triglycerides and depressed HDL cholesterol. As such, when treating the obese,
hypertensive population, the provider will need to focus on the overall cardiovascular health of the
individual.
Obesity is not equally distributed across populations. African-Americans (AA), particularly
women, have the highest prevalence of obesity of any racial group in the U.S. 6 Not surprisingly,
AA, especially women, also have the highest prevalence of HTN in the U.S. 7 The consequence of
disproportionate obesity in some populations is that CV morbidity and mortality is also not equally
distributed among populations. The reasons for differences in overweight and obesity among AA (and
Hispanics) compared to non-Hispanic whites has little to do with genetic differences and much to do
with cultural and socio-economic differences. 8, 9 Also, African American women consume more calories
and exercise less than their white counterparts beginning in their late teens.
A number of cultural norms can impact the development and progression of obesity. For
example, AA and Hispanics have a number of traditional foods that we now appreciate as calorie-dense
and carbohydrate rich that directly contribute to increased caloric intake and obesity. Such culturally-
linked food preferences are introduced early, increasing the challenge for both patients and providers
to modify intake. 10 In addition, foods that may pose substantial health risk are frequently targeted
to minority populations. 11 The cultural norms that define beauty in cultures also clearly impact the
likelihood willful caloric restriction, particularly in women. 12 Cultural differences in levels of exercise and
physical activity also likely play a substantive role in obesity risk. 13 Modification is further complicated
in individuals with limited financial resources. An awareness of cultural differences that may impact
obesity and HTN is necessary to help individuals modify their bodyweights within the context of their
daily experiences and expectations.
Socio-economic differences across populations play a significant role in the development of
obesity and as a consequence, HTN. Among the poor in this country, obesity is disproportionately
prevalent. As AA and Hispanics are disproportionately poor, we see excessive obesity in these groups. 9
Individuals with limited incomes are at dual disadvantages. First, they often cannot afford healthier
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