Black-white comparison of indices of coronary heart disease and myocardial infarction in the stepped-care cohort of the Hypertension Detection and Follow-Up Program.

As part of the initial examination of individuals enrolled in the Hypertension Detection and Follow-Up Program, a standardized questionnaire to elicit symptoms of angina pectoris and myocardial infarction and to inquire about the clinical diagnosis of myocardial infarction was administered. Angina pectoris was more prevalent in black males than white males and more prevalent in black females than white females. In white and black males and in white females, baseline prevalence of angina was associated with an approximate doubling of the 5-year mortality. A positive Rose Questionnaire for myocardial infarction, a positive clinical history of myocardial infarction, or a positive ECG for myocardial infarction was also associated with increased mortality in all of the race-sex groups, with the exception of black females, in whom the ECG evidence of myocardial infarction at baseline was only modestly associated with mortality. The Rose Questionnaire evidence of myocardial infarction was actually associated with a lesser 5-year mortality. The higher prevalence of angina pectoris in black hypertensive males in the face of a high prevalence of hypertension in blacks suggests that the combination of coronary artery disease and hypertension is more of a health problem in black males than in white males. The situation in black females, however, is less clear. The 5-year incidence of myocardial infarction, positive ECG or history, or positive Rose Questionnaire was approximately equal in blacks and whites among the treated hypertensive patients.