Hypertension in blacks: psychosocial and biological perspectives

The extraordinarily high rate of hypertension in blacks remains a significant public health issue in most industrialized societies. Research has focused on the investigation of racial differences in biological, nutritional, behavioural and psychological, and social factors in an effort to identify the causes of this high morbidity rate. Thus far, research suggests important racial differences in renal functioning, particularly in sodium metabolism and plasma renin activity, as well as potassium intake and sodium:potassium ratio. Behavioral factors such as anger-coping style and John Henryism, and social factors such as socioeconomic status, socioecological stress, social support, urban-rural residence, and family interaction patterns have also been identified as potential contributors. Finally, emerging research paradigms such as laboratory stress reactivity and 24-h ambulatory monitoring of blood pressure may provide promising leads about the interaction between these effects and hypertension in black populations.