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Hypertension: racial differences
1Department of Physiology and Biophysics, Georgetown University School of Medicine, Washington, DC 20007.
Insights
Hypertension is more prevalent in Black populations and presents with distinct characteristics. Management strategies should prioritize salt restriction and specific antihypertensive agents for Black individuals.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Nephrology
Background:
- Hypertension prevalence, clinical course, and pathophysiology differ between Black and White populations.
- Epidemiologic data show higher hypertension rates in Black individuals across matched age and sex groups.
- Hypertensive Black individuals exhibit increased risks for left ventricular dysfunction, stroke, and renal damage, but lower risk for ischemic heart disease compared to White individuals.
Purpose of the Study:
- To review racial differences in hypertension between Black and White populations.
- To highlight distinct pathophysiologic characteristics, including salt sensitivity and renin levels.
- To recommend tailored management strategies for hypertension in Black individuals.
Main Methods:
- Review of accumulated epidemiologic data.
- Analysis of pathophysiologic differences, including salt sensitivity, renin levels, and dopamine response.
- Synthesis of clinical course and outcome data.
Main Results:
- Black populations exhibit higher hypertension prevalence and distinct clinical outcomes.
- Significant pathophysiologic differences include salt sensitivity and lower renin levels in Black individuals.
- Dopamine response to salt load is diminished in Black individuals.
Conclusions:
- Hypertension management in Black individuals should initially focus on salt restriction.
- If dietary changes are insufficient, antihypertensive agents with 24-hour efficacy, reduced vascular resistance, and natriuretic properties are recommended.
- Calcium channel blockers may be suitable for managing hypertension in Black patients due to their potential to meet these criteria.
Abstract:
Racial differences in the prevalence, course, and pathophysiologic characteristics of hypertension in black and white populations are reviewed. Accumulated epidemiologic data indicate that the prevalence of hypertension among blacks is greater than that among whites in almost all age- and sex-matched groups. Hypertensive blacks have a higher incidence of left ventricular dysfunction, stroke, and renal damage, but a lower incidence of ischemic heart disease, than do hypertensive whites. A significant pathophysiologic difference between blacks and whites is salt sensitivity; normotensive, as well as hypertensive, blacks tend to be salt sensitive. Blacks also tend to have lower renin levels than do whites, while dopamine response to a salt load is diminished among blacks as compared with whites. These differences and others lead to the recommendation that hypertension among blacks should be managed initially with salt restriction; if dietary control is insufficient, administration of an antihypertensive agent with 24-hour efficacy, which lowers vascular peripheral resistance, promotes sodium excretion, and potentially improves renal hemodynamics, is recommended. A calcium channel blocker may satisfy these requirements.