More than 75,000 deaths over the course of a decade could be prevented if Black adults in the US achieved the same median blood pressure as White adults, a new modeling study suggested.

The new analysis serves as a powerful reminder that equity is a key component of disease prevention, according to the researchers, who published their findings in JAMA Network Open.

“We expected large benefits from reducing big disparities, but the sheer number of preventable events among people already taking antihypertensive medication shows we must do more to prevent hypertension through healthy lifestyles and overcome clinical inertia in treatment,” said Shakia T. Hardy, PhD, epidemiologist at the University of North Carolina at Chapel Hill, who led the study.

Hardy and colleagues analyzed data from 2015 to 2020 to calculate differences in the 10-year cumulative incidence of cardiovascular disease and associated mortality between Black and White adults. More than 82 million adults were included (mean age, 61 years; 45.3% male; 87.8% White).

The mean systolic blood pressure (SBP) at baseline for Black and White patients not taking antihypertensive medication was 130.7 and 124.2 mm Hg, respectively. For those taking the drugs, mean SBP was 137.8 mm Hg for Black people and 131.2 mm Hg for White people.

In the model, achieving equity between the two groups reduced cardiovascular events by 50,434 over 10 years among Black patients who were not taking antihypertensive drugs and by 122,881 among those who were taking the medications.

Reaching the same mean SBP also reduced the number of cardiovascular deaths by 21,703 among Black patients not taking antihypertensive medication and 55,055 among those taking medication, the model projected. The majority of these deaths occurred in adults aged 45-64 years.

Clinicians should prioritize prevention and optimal treatment by promoting healthy lifestyles for those without hypertension and intensifying therapy when blood pressure remains uncontrolled, Hardy said.

“Overcoming clinical inertia and ensuring equitable, guideline-based care are essential to reducing cardiovascular disparities,” she said. “Future research should test community, clinical, and policy interventions that reduce blood pressure disparities and address their root causes.”

The magnitude of preventable deaths and events is sobering but not surprising, said Annie DePasquale, MD, family medicine physician in Arlington, Virginia. The effect of small, sustained reductions in SBP is already well known, she said.

But “what stands out here is how directly systolic blood pressure equity maps to prevent events and deaths,” DePasquale, who was not involved in the study, told Medscape Medical News. “Hypertension drives a disproportionate share of cardiovascular disease in Black communities, yet the impact of closing the systolic blood pressure gap has been hard to quantify.”

The takeaway for primary care specialists is to treat blood pressure control as both a clinical goal and an equity imperative, DePasquale said. She recommended clinicians conduct home monitoring and provide rapid medication titration in primary care, especially for patients facing barriers to blood pressure control, such as access to consistent treatment.

“We need real-world implementation studies that pair evidence-based blood pressure care with community-anchored strategies: coverage for home cuffs, pharmacy-led titration, and community health worker support, plus rigorous cost-effectiveness analyses to scale what works,” DePasquale said.

The study was funded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging. Hardy reported receiving grant support from the National Heart, Lung, and Blood Institute. DePasquale reported having no financial conflicts of interest.