Akinkugbe O O
Department of Medicine, University of Ibadan, Nigeria.
J Hypertens Suppl. 1990 Dec;8(7):S233-8.
As infection and malnutrition are steadily overcome in the developing world, cardiovascular disease loom large in the profile of morbidity and mortality in these societies. Hypertension, rheumatic heart disease and the cardiomyopathies are already taking their toll and atherosclerosis is certain to pose public health problems soon unless steps are taken now, through attention to known risk factors, to pre-empt or at least minimize its consequences. There are populations in developing countries among whom blood pressure does not appear to rise with age and in whom the prevalence of hypertension is very low. Studies of these communities and of migrant groups indicate that salt has an important effect on blood pressure. In spite of these observations, however, it is well known that black communities tend, on the whole, to show a higher prevalence of hypertension and more severe target-organ damage than white communities. Other distinguishing features are lower cholesterol, triglyceride and low-density lipoprotein fractions and a delayed response to a sodium load in black populations. Economic constraints limit the effective application of stepped-care therapy in the management of moderate to severe hypertension. Beta-blockers and angiotensin converting enzyme (ACE) inhibitors are not so effective in black communities unless combined with diuretics.
在发展中国家，随着感染和营养不良问题逐步得到解决，心血管疾病在这些社会的发病率和死亡率中占据了显著地位。高血压、风湿性心脏病和心肌病已经造成了损害，而动脉粥样硬化肯定会很快引发公共卫生问题，除非现在就通过关注已知的风险因素采取措施，以预防或至少减轻其后果。在发展中国家，有些人群的血压似乎不会随着年龄增长而升高，高血压患病率也很低。对这些社区和移民群体的研究表明，盐对血压有重要影响。然而，尽管有这些观察结果，但众所周知，总体而言，黑人社区的高血压患病率往往高于白人社区，且靶器官损害更为严重。其他显著特征是黑人人群的胆固醇、甘油三酯和低密度脂蛋白水平较低，对钠负荷的反应延迟。经济限制阻碍了阶梯式护理疗法在中重度高血压治疗中的有效应用。β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂在黑人社区效果不佳，除非与利尿剂联合使用。
