A mechanism for the development of fixed primary (essential) hypertension: insights from population-based studies...

Two recent observations based on echocardiographic studies in large population-based studies may have far-reaching implications: The concentric form of left ventricular hypertrophy emerges prominently in white Framingham (MA) men aged 40-49 years, and ten years later in white Framingham women. This parallels the pattern of emergence of fixed primary hypertension in white Framingham adults. Normotensive black teenage boys in Bogalusa have an echocardiographic profile that parallels more closely the profile of middle-aged white Framingham men and women than white teenage boys and girls. As noted, the former echocardiographic profiles are strongly associated with fixed primary hypertension in older adults and may be the harbingers of the premature development of fixed primary hypertension in the young black boys. These findings fit into a chain of observations that: (1) give new insight into the mechanism for premature development of primary hypertension and that should ultimately lead to closing the loop needed to characterize the cause of such hypertension: (2) may ultimately help to explain the excess of premature cardiovascular, renal, and cerebrovascular morbidity and mortality in the U.S. black population compared with the white population; and (3) may lead to new, more effective strategies for reducing such excess morbidity and mortality.