The kidney in the hypertensive black

Evidence suggests that the incidence of end-stage renal disease due to essential hypertension is five to six times more frequent in black than in white patients. The reason for this greater susceptibility is not clear. Several possibilities have been proposed, including socioeconomic factors, compliance with therapy, renal hemodynamic differences and anatomic differences. In this review, we propose that the greater propensity of black hypertensives to develop renal failure as a consequence of hypertension may be due to abnormal hemodynamic adaptation of the renal circulation to a rise in blood pressure caused by high dietary sodium intake. This would make the renal circulation of hypertensive blacks more susceptible to injury.