Title: Why Do Black Americans Have Higher Prevalence of Hypertension? | Hypertension
Headings: Why Do Black Americans Have Higher Prevalence of Hypertension?
Why Do Black Americans Have Higher Prevalence of Hypertension?
An Enigma Still Unsolved
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Content: Previous Version 1
See related article, pp 383–389
Studies have consistently reported a higher prevalence of hypertension in blacks than in whites, a main reason for the higher incidence of cardiovascular disease in blacks. 1 The long list of putative causes for this higher prevalence suggests that the real reasons are still unknown. Biological differences in the mechanisms of blood pressure control or in the environment and habits of whites and blacks are among the potential causes. The higher prevalence of hypertension in blacks living in the United States instead of Africa 2 demonstrates that environmental and behavioral characteristics are the more likely reasons for the higher prevalence in blacks living in the United States. They could act directly or by triggering mechanisms of blood pressure increase that are dormant in blacks living in Africa. Kaplan and Victor 3 listed 18 genotypes and intermediate phenotypes that were implicated with an increase of blood pressure in blacks. A higher sensitivity to alcohol could be added to that list. 4 Some of these mechanisms, such as a higher renal retention of sodium by blacks, are attractive. The “slavery hypertension hypothesis” states that the higher prevalence of hypertension among blacks could have resulted from an enhanced ability to conserve salt by slaves, protecting them from fatal salt-depletive diseases during the stormy Atlantic passage, such as diarrhea and vomiting. 5 This condition would induce hypertension when they and their descendants consumed the much higher sodium content in American compared with African foods.