Title: Hypertension in Blacks | Hypertension
Headings: Hypertension in Blacks
Hypertension in Blacks
Individualized Therapy Based on Renin/Aldosterone Phenotyping
Black Hypertensives Tend to Retain Salt and Water
Black Hypertensives Are More Likely to Have a Liddle Phenotype
Black Hypertensives Are More Likely to Have Primary Aldosteronism
Black Patients Respond Preferentially to Diuretics
African Diaspora Hypothesis
Physiologically Individualized Therapy Based on Plasma Renin and Aldosterone
Conclusions
Acknowledgments
Disclosures
Footnotes
References

Content: failure to investigate the underlying cause of hypertension. 12, 13 It is diagnostic inertia that we seek to diminish by this review. In the REGARDS study, between the 45 and 64 years of age (an age group in which blacks are at 2×–3× the risk of stroke as whites), ≈40% of the excess stroke risk in blacks was attributable to traditional stroke risk factors, with levels of systolic BP accounting for approximately one half of this impact. 2 “For each 10 mm Hg increase in levels of SBP, the increased stroke risk in whites is ≈8%; however, a similar 10 mm Hg increase in SBP in African Americans is associated with a 24% increase in stroke risk, an impact 3 times greater than in whites.” Furthermore, black patients were more likely to be aware they were hypertensive, more likely to be treated for hypertension, more likely to treated more intensively, but less likely to have their BP controlled. 2 Hypertension was also more severe in blacks; at baseline, ≈40% of blacks but only 25% of whites had systolic pressures >160 mm Hg. 2
Hypotheses seeking to explain the excess of hypertension in blacks have tended to emphasize psychological stress and socioeconomic factors. 14 In this review, we focus on biological reasons for the disparity in hypertension and stroke, because they are within the purview of physicians and provide at least a partial solution to this disparity that can be implemented immediately.