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[The entity of arterial hypertension in black subjects]
1INSERM U258, Hôpital Broussais, Paris.
Insights
High blood pressure (hypertension) prevalence varies globally in Black populations. Lifestyle and socioeconomic factors, not skin color, likely explain differences in hypertension prevalence and complications.
Area of Science:
- Cardiology
- Public Health
- Genetics
Background:
- High blood pressure (hypertension) is a significant clinical concern in Black subjects due to its high prevalence, severe complications, and unique pathophysiological and therapeutic characteristics.
- Global data from 52 centers across 32 countries reveal substantial variability in hypertension prevalence and severity among Black populations.
- For instance, Black individuals in the United States exhibit high mean blood pressure (128/81 mmHg) and a hypertension prevalence of 33.5%, contrasting sharply with an ethnic population in Kenya (110/68 mmHg; 5% prevalence).
Discussion:
- Black populations experience more frequent and severe hypertension-related complications, including increased morbidity from left ventricular hypertrophy (2x) and end-stage renal failure (4.2x), and higher mortality from cerebrovascular diseases (1.5x) compared to White populations in the US.
- However, risk factors such as overweight, alcohol consumption, sodium intake, and socioeconomic environment appear to account for the majority of these observed differences.
- Disparities in diagnostic practices and treatment management may also contribute to the observed variations.
Key Insights:
- Hypertension prevalence and severity differ significantly among Black populations worldwide.
- Lifestyle, environmental, and socioeconomic factors are primary drivers of hypertension disparities, not genetic markers based on skin color.
- While genetic factors may play a role, current scientific evidence does not support using race as a biological determinant for high blood pressure.
Outlook:
- Further research is needed to elucidate the complex interplay of genetic, environmental, and socioeconomic factors influencing hypertension in diverse Black populations.
- Developing targeted public health interventions and culturally sensitive clinical management strategies is crucial for reducing the burden of hypertension and its complications.
- Longitudinal studies investigating the impact of lifestyle modifications and socioeconomic interventions on blood pressure control are warranted.
Abstract:
High blood pressure in black subjects has been recognized as a clinical entity because of high prevalence, frequent severe complications and pathophysiological and therapeutic specificities. Results from 52 centers in 32 countries show wide variability. In the black population in United States, mean systolic and diastolic blood pressure levels are high, 128/81 mmHg, with a prevalence of hypertension reaching 33.5%, while an ethnic population in Kenya has low mean levels, 110/68 mmHg, with a hypertension prevalence of only 5%. Complications have been reported to be more frequent in black populations. In the United States, in comparison with the white population morbidity due to left ventricular hypertrophy is increased by 2, end-stage renal failure by 4.2 and mortality due to cerebral vascular diseases by 1.5. However, risk factors including over-weight, alcohol consumption, sodium intake and the socioeconomic environment have been shown to explain most of the differences between the white and the black populations. Differences in diagnosis and management may also play a role. Indeed, while genetic selection may have had an effect, there is no current scientific data which would justify using the colour of the skin as a genetic marker for high blood pressure.