Perspectives of hypertension in black patients: black vs. white differences.

Hypertension is a major disease in the black population of sub-Saharan Africa and the U.S. The prevalence of hypertension varies from 1-30% of the adult population. Differences in blood pressure (BP) between black and white patients have been documented. In this review, genetic, endocrine, and environmental characteristics, renal physiology, and cardiac function are reviewed. Racial differences in renal physiology and socioeconomic status seem to account for BP differences. Black hypertensive patients in sub-Saharan Africa are prone to cerebral hemorrhage, malignant hypertension leading to uremia, and congestive heart failure, whereas coronary artery disease is uncommon. Responses to hypotensive agents like beta-blockers and angiotensin-converting enzyme inhibitors are poor unless these agents are combined with a thiazide diuretic. Black hypertensive patients respond best to diuretics, vasodilators, or calcium channel blockers. A profiled approach to the treatment of hypertension is suggested.