Recent declines of hypertensive renovasculopathies in New Orleans blacks

Some evidence indicates that renovasculopathies measured in paraffin sections of renal cortex obtained at autopsy might offer a general guide to prevailing mean blood pressure (MBP) in the averages of demographic groups. In this study, data on forensic autopsies done in New Orleans from 1968 to 1998 were retrieved from computer archives. Observations are confined to basal cases (ie, those with causes of death having no known correlation with hypertension and therefore, who can be taken as approximately representative of the sampled populations, although overt hypertensives may be underrepresented in such a series). MBP derived from renovasculopathies were used to follow birth date cohorts born around the years 1928, 1938, 1948, 1958, 1968, and 1978. Vasculopathy-derived MBP of white men and women increased with age in a stable pattern with no shifting of positions among the cohorts. This pattern offered a baseline for comparison with the data on blacks. Against this baseline, blacks displayed the highest MBP in the earliest cohort with stair-step declines in later born cohorts, and an abrupt decrease between the 1958 and 1968 cohorts. Data from National Health And Nutrition Examination Surveys are generally supportive of these conclusions, but are of uncertain significance because of severe downward drift due to method changes in the National Health And Nutrition Examination Survey III 1988-91 survey. The data analyzed here provide no direct evidence on the matter of whether we are gaining better blood pressure control in hypertensive individuals who really need it.