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Racial Differences in Hypertension: Implications for High Blood Pressure Management

  • Daniel T. Lackland
    Correspondence
    Correspondence: Daniel T. Lackland, DrPH, Department of Neurosciences, Medical University of South Carolina, Suite 501, Harborview Office Tower, Charleston, SC 29425
    Affiliations
    From the Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
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      Abstract

      The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African Americans with greater risks than caucasians. Blood pressure levels have consistently been higher for African Americans with an earlier onset of hypertension. Although awareness and treatment levels of high blood pressure have been similar, racial differences in control rates are evident. The higher blood pressure levels for African Americans are associated with higher rates of stroke, end-stage renal disease and congestive heart failure. The reasons for the racial disparities in elevated blood pressure and hypertension-related outcomes risk remain unclear. However, the implications of the disparities of hypertension for prevention and clinical management are substantial, identifying African American men and women with excel hypertension risk and warranting interventions focused on these differences. in addition, focused research to identify the factors attributed to these disparities in risk burden is an essential need to address the evidence gaps.

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      REFERENCES

        • Lackland D.T.
        • Bachman D.L.
        • Carter T.D.
        • et al.
        The geographic variation in stroke incidence in two areas of the southeastern stroke belt: the Anderson and Pee Dee Stroke Study.
        Stroke. 1998; 29: 2061-2068
        • Ford E.S.
        Trends in mortality from all causes and cardiovascular disease among hypertensive and nonhypertensive adults in the United States.
        Circulation. 2011; 123: 1737-1744
        • Lackland D.T.
        • Keil J.E.
        • Gazes P.C.
        • et al.
        Outcomes of black and white hypertensive individuals after 30 years of follow-up.
        Clin Exp Hypertens. 1995; 17: 1091-1105
        • Keil J.E.
        • Sutherland S.E.
        • Knapp R.G.
        • et al.
        Mortality rates and risk factors for coronary disease in blacks as compared with white men and women.
        N Engl J Med. 1993; 329: 73-78
        • Keil J.E.
        • Sutherland S.E.
        • Hames C.G.
        • et al.
        Coronary disease mortality in black and white men.
        Arch Intern Med. 1995; 155: 1521-1527
        • Li X.
        • Li S.
        • Ulusoy E.
        • et al.
        Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa Heart Study.
        Circulation. 2004; 110: 3488-3492
        • Taylor H.A.
        Establishing a foundation for cardiovascular disease research in an African American community: the Jackson Heart Study.
        Ethn Dis. 2003; 13: 411-413
        • Howard G.
        • Prineas R.
        • Moy C.
        • et al.
        Racial and geographic differences in awareness, treatment, and control of hypertension: the REasons for Geographic And Racial Differences in Stroke study.
        Stroke. 2006; 37: 1171-1178
        • Lackland D.T.
        • Keil J.E.
        Epidemiology of hypertension in African Americans.
        Semin Nephrol. 1996; 16: 63-70
        • Burt V.L.
        • Whelton P.
        • Roccella E.J.
        • et al.
        Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991.
        Hypertension. 1995; 25: 305-313
        • Hertz R.P.
        • Unger A.N.
        • Cornell J.A.
        • et al.
        Racial disparities in hypertension prevalence, awareness, and management.
        Arch Intern Med. 2005; 165: 2098-2104
        • Cutler J.A.
        • Sorlie P.D.
        • Wolz M.
        • et al.
        Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004.
        Hypertension. 2008; 52: 818-827
        • Guo F.
        • He D.
        • Zhang W.
        • et al.
        Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010.
        J Am Coll Cardiol. 2012; 60: 599-606
        • Muntner P.
        • He J.
        • Cutler J.A.
        • et al.
        Trends in blood pressure among children and adolescents.
        JAMA. 2004; 291: 2107-2113
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        • et al.
        Heart disease and stroke statistics-2013 update: a report from the American Heart Association.
        Circulation. 2013; 127: e6-e245
        • Lackland D.T.
        Racial disparities in hypertension.
        J Clin Hypertens (Greenwich). 2005; 7: 500-502
        • Lackland D.T.
        High blood pressure: a lifetime issue.
        Hypertension. 2009; 54: 457-458
        • Hajjar I.
        • Kotchen T.A.
        Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1998–2000.
        JAMA. 2003; 290: 199-206
        • Lloyd-Jones D.M.
        • Evans J.C.
        • Larson M.G.
        • et al.
        Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community.
        Hypertension. 2000; 36: 594-599
        • Bosworth H.B.
        • Powers B.
        • Grubber J.M.
        • et al.
        Racial differences in blood pressure control: potential explanatory factors.
        J Gen Intern Med. 2008; 23: 692-698
        • Ostchega Y.
        • Yoon S.S.
        • Hughes J.
        • et al.
        Hypertension awareness, treatment, and control – continued disparities in adults: United States, 2005–2006. National Center for Health Statistics, NCHS data brief no Hyattsville, MD2008
        • Svetkey L.P.
        • Simons-Martin D.
        • Vollmer W.M.
        Effects of dietary patterns on blood pressure: subgroup analysis of the dietary approaches to stop hypertension (DASH) randomized clinical trial.
        Arch Intern Med. 1999; 159: 285-293
        • Vollmer W.M.
        • Sacks F.M.
        • Ard J.
        • et al.
        Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial.
        Ann Intern Med. 2001; 135: 1019-1028
        • Materson B.J.
        • Reda D.
        • Cushman W.C.
        Department of veterans affairs cooperative study group on antihypertensive agents. Department of veterans affairs and new data.
        Am J Hypertens. 1995; 8: 189-192
        • Saunders E.
        • Weir M.R.
        • Kong B.W.
        • et al.
        A comparison of the efficacy and safety of a beta-blocker, a calcium channel blocker, and a converting enzyme inhibitor in hypertensive blacks.
        Arch Intern Med. 1990; 150: 1707-1713
        • Moser M.
        • Lunn J.
        Responses to captopril and hydrochlorothiazide in black patients with hypertension.
        Clin Pharmacol Ther. 1982; 32: 307-312
        • Weir M.R.
        • Gray J.M.
        • Paster R.
        • et al.
        Differing mechanisms of action of angiotensin-converting enzyme inhibition in black and white hypertensive patients.
        Hypertension. 1995; 26: 124-130
        • Cohn J.N.
        Contemporary treatment of heart failure: is there adequate evidence to support a unique strategy for African Americans? Pro position.
        Curr Hypertens Rep. 2002; 4: 307-310
        • Gazes P.C.
        • Lackland D.T.
        • Mountford W.K.
        • et al.
        Comparison of cardiovascular risk factors for high brachial pulse pressure in blacks versus whites (Charleston Heart Study, Evans County Study, NHANES I and II Studies).
        Am J Cardiol. 2008; 102: 1514-1517
        • Howard G.
        • Lackland D.T.
        • Kleindorfer D.O.
        • et al.
        Racial differences in the impact of elevated systolic blood pressure on stroke risk.
        JAMA Intern Med. 2013; 173: 46-51
        • Lackland D.T.
        • Egan B.M.
        • Mountford W.K.
        • et al.
        Thirty-year survival for black and white hypertensive individuals in the Evans County Heart Study and the hypertension detection and follow-up program.
        J Am Soc Hypertens. 2008; 2: 448-454
        • Jones D.W.
        • Hall J.E.
        Racial and ethnic differences in blood pressure: biology and sociology.
        Circulation. 2006; 114: 2757-2759
        • Andrew M.E.
        • Jones D.W.
        • Wofford M.R.
        • et al.
        Ethnicity and unprovoked hypokalemia in the atherosclerosis risk in Communities Study.
        Am J Hypertens. 2002; 15: 594-599
        • Wright J.T.
        • Scarpa M.A.
        • Fatholahi M.
        • et al.
        Determinants of salt sensitivity in black and white normotensive and hypertensive women.
        Hypertension. 2003; 42: 1087-1092
        • Lackland D.T.
        • Orchard T.J.
        • Keil J.E.
        • et al.
        Are race differences in the prevalence of hypertension explained by body mass and fat distribution?.
        Int J Epidemiol. 1992; 21: 236-245
        • Wang X.
        • Poole J.C.
        • Treiber F.A.
        • et al.
        Ethnic and gender differences in ambulatory blood pressure trajectories: results from a 15-year longitudinal study in youth and young adults.
        Circulation. 2006; 114: 2780-2787
        • Calhoun D.A.
        • Jones D.
        • Rextor S.
        • et al.
        American Heart Association scientific statement on resistant hypertension: diagnosis, evaluation, and treatment.
        Hypertension. 2008; 51: 1403-1419
        • Calhoun D.A.
        • Booth J.N.
        • Oparil S.
        • et al.
        Refractory hypertension: determination of prevalence, risk factors, and comorbidities in a large, population-based cohort.
        Hypertension. 2014; 63: 451-458
        • Lillie-Blanton M.
        • Parsons P.E.
        • Gayle H.
        • et al.
        Racial differences in health: not just black and white, but shades of gray.
        Annu Rev Public Health. 1996; 17: 411-448
        • Lackland D.T.
        • Lin Y.
        • Tilley B.C.
        • et al.
        An assessment of racial differences in clinical practices for hypertension at primary care sites for medically underserved patients.
        J Clin Hypertens (Greenwich). 2004; 6: 26-33
        • Lackland D.T.
        Fetal and early life determinants of hypertension in adults: implications for study.
        Hypertension. 2004; 44: 811-812
        • Douglas J.G.
        • Bakris G.L.
        • Epstein M.
        • Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks
        • et al.
        Management of high blood pressure in African Americans: consensus statement of the hypertension in African Americans Working Group of the International Society on Hypertension in Blacks.
        Arch Intern Med. 2003; 163: 525-541
        • Lackland D.T.
        • Roccella E.J.
        • Deutsch A.F.
        • American Heart Association Stroke Council
        • Council on Cardiovascular and Stroke Nursing
        • Council on Quality of Care and Outcomes Research
        • Council on Functional Genomics and Translational Biology
        • et al.
        Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association.
        Stroke. 2014; 45: 315-353
        • Chobanian A.V.
        • Bakris G.L.
        • Black H.R.
        • National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and National High Blood Pressure Education Program Coordinating Committee
        • et al.
        The Seventh report of the Joint National Committee on prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
        JAMA. 2003; 289: 2560-2572
        • James P.A.
        • Oparil S.
        • Carter B.L.
        • et al.
        2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).
        JAMA. 2014; 311: 507-520
      1. Wright JT, Fine LJ, Lackland DT, et al. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med Available at http://annals.org/. Accessed January 13, 2014.