Ethnicity and hypertension

ESC CardioMed ◽

10.1093/med/9780198784906.003.0700 ◽

2018 ◽

pp. 2895-2898

Author(s):

Bert-Jan van den Born ◽

Charles Agyemang

Keyword(s):

United States ◽

Blood Pressure ◽

Calcium Channel ◽

Ethnic Differences ◽

European Society ◽

The United States ◽

Hypertension Prevalence ◽

Blocking Agents ◽

Pressure Lowering ◽

And Control

Worldwide, large differences exist in the prevalence of hypertension and hypertension-related complications, both along geographic boundaries and between different ethnic groups. Urbanization and dietary changes have led to a genuine increase in hypertension prevalence in many low- and middle-income countries, whereas migration has been associated with disparities in hypertension prevalence, awareness, and control in different, large multi-ethnic populations in Europe and the United States. Depending on the geographic area and definition of ethnicity, results can be quite heterogeneous and are susceptible to generalization. However, data in both Europe and the United States consistently show higher prevalence rates of hypertension and hypertension-related complications in populations of West African descent. These ethnic differences in hypertension susceptibility may in part be attributable to quantitative differences in other risk factors such as obesity and dietary salt intake, but may also relate to differences in pathophysiological traits, particularly increased salt sensitivity and vascular contractility. This may also explain the better blood pressure-lowering potential of salt restriction and of pharmacological treatment with diuretics and calcium channel blocking agents, whereas renin–angiotensin system blockers and beta-blocking agents are in general less effective. The European Society of Hypertension/European Society of Cardiology Guidelines recommend to start with calcium channel blockers or a thiazide diuretic for the treatment of hypertension in sub-Saharan African populations if no other compelling indications are present, while there is a lack of evidence that ethnicity should influence the preference for particular blood pressure-lowering combinations. The realization that ethnic differences in hypertension prevalence and treatment response exist may help to increase our understanding of the complex pathophysiology of hypertension and improve strategies aimed at the selection and control of hypertensive patients with different ethnic background.

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Ethnicity and hypertension

ESC CardioMed ◽

10.1093/med/9780198784906.003.0700_update_001 ◽

2018 ◽

pp. 2895-2898

Author(s):

Bert-Jan van den Born ◽

Charles Agyemang

Keyword(s):

United States ◽

European Society ◽

African Descent ◽

Renin Angiotensin System ◽

The United States ◽

Angiotensin System ◽

Hypertension Prevalence ◽

Blocking Agents ◽

Sub Saharan ◽

And Control

Worldwide, large differences exist in the prevalence of hypertension and hypertension-mediated complications, both along geographic boundaries and between different ethnic groups. Urbanization and dietary changes have led to a genuine increase in hypertension prevalence in many low- and middle-income countries, whereas migration has been associated with disparities in hypertension prevalence, awareness, and control in different, multi-ethnic populations in Europe and the United States. Depending on the geographic area and definition of ethnicity results can be quite heterogeneous and are susceptible to generalization, but data in both Europe and the United States consistently show higher prevalence rates of hypertension and hypertension-mediated complications in populations of West African descent. These ethnic differences in hypertension susceptibility may in part be attributable to quantitative differences in other risk factors such as obesity and dietary salt intake, but may also relate to differences in physiological traits, in particular salt sensitivity and vascular contractility. While there is little evidence for a different reaction to blood pressure-lowering therapy in other ethnic groups, thiazide diuretics and calcium channel blocking agents are generally more effective in sub-Saharan African descent populations compared with renin–angiotensin system blockers and beta-blocking agents. The 2018 European Society of Hypertension/European Society of Cardiology Guidelines recommend to start withsingle-pill combinationtherapy in most hypertensive patients and to start with thiazide or thiazide-like diuretics and calciumchannel blockers in sub-Saharan African descent populationseithercombined with each other or with a renin–angiotensin system blocker as they make the latter more effective. The observeddisparities in hypertension prevalence and treatment responsesmay also help to increase our understanding of the complex pathophysiology of hypertension and improve strategies aimed at the selection and control of hypertension in the population at large.

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IMPROVING HYPERTENSION CONTROL IN THE UNITED STATES: UNDERSTANDING RACIAL/ETHNIC DIFFERENCES IN THE BLOOD PRESSURE CASCADE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02833-3 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1475

Author(s):

Rahul Aggarwal ◽

Nicholas Chiu ◽

Rishi Wadhera ◽

Andrew Moran ◽

Changyu Shen ◽

...

Keyword(s):

United States ◽

Blood Pressure ◽

Ethnic Differences ◽

The United States ◽

Hypertension Control ◽

Racial Ethnic

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Racial/Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018

Hypertension ◽

10.1161/hypertensionaha.121.17570 ◽

2021 ◽

Author(s):

Rahul Aggarwal ◽

Nicholas Chiu ◽

Rishi K. Wadhera ◽

Andrew E. Moran ◽

Inbar Raber ◽

...

Keyword(s):

United States ◽

Ethnic Disparities ◽

The United States ◽

Self Report ◽

Similar Treatment ◽

Hypertension Prevalence ◽

Health And Nutrition ◽

Race Ethnicity ◽

And Control ◽

White Adults

We evaluated the prevalence, awareness, treatment, and control of hypertension (defined as a systolic blood pressure [BP]) ≥140 mm Hg, diastolic BP ≥90 mm Hg, or a self-reported use of an antihypertensive agent) among US adults, stratified by race/ethnicity. This analysis included 16 531 nonpregnant US adults (≥18 years) in the three National Health and Nutrition Examination Survey cycles between 2013 and 2018. Race/ethnicity was defined by self-report as White, Black, Hispanic, Asian, or other Americans. Among 76 910 050 (74 449 985–79 370 115) US adults with hypertension, 48.6% (47.3%–49.8%, unadjusted) have controlled BP. When compared with BP control rates for White adults (49.0% [46.8%–51.2%], age-adjusted), BP control rates are lower in Black (39.2%, adjusted odds ratio [aOR], 0.71 [95% CI, 0.59–0.85], P <0.001), Hispanic (40.0%, aOR, 0.71 [95% CI, 0.58–0.88], P =0.003), and Asian (37.8%, aOR, 0.68 [95% CI, 0.55–0.84], P =0.001) Americans. Black adults have higher hypertension prevalence (45.3% versus 31.4%, aOR, 2.24 [95% CI, 1.97–2.56], P <0.001) but similar awareness and treatment rates as White adults. Hispanic adults have similar hypertension prevalence, but lower awareness (71.1% versus 79.1%, aOR, 0.72 [95% CI, 0.58–0.89], P =0.005) and treatment rates (60.5% versus 67.3%, aOR, 0.78 [95% CI, 0.66–0.94], P =0.010) than White adults. Asian adults have similar hypertension prevalence, lower awareness (72.5% versus 79.1%, aOR, 0.75 [95% CI, 0.58–0.97], P =0.038) but similar treatment rates. Black, Hispanic, and Asian Americans have different vulnerabilities in the hypertension control cascade of prevalence, awareness, treatment, and control. These differences can inform targeted public health efforts to promote health equity and reduce the burden of hypertension in the United States.

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Forty-Year Shifting Distribution of Systolic Blood Pressure With Population Hypertension Treatment and Control

Circulation ◽

10.1161/circulationaha.120.048063 ◽

2020 ◽

Vol 142 (16) ◽

pp. 1524-1531 ◽

Cited By ~ 1

Author(s):

Daniel T. Lackland ◽

Virginia J. Howard ◽

Mary Cushman ◽

Suzanne Oparil ◽

Brett Kissela ◽

...

Keyword(s):

United States ◽

Blood Pressure ◽

High Risk ◽

Racial Differences ◽

The United States ◽

Hypertension Treatment ◽

Heart Study ◽

Blacks And Whites ◽

The 1960S ◽

And Control

Background: Hypertension awareness, treatment, and control programs were initiated in the United States during the 1960s and 1970s. Whereas blood pressure (BP) control in the population and subsequent reduced hypertension-related disease risks have improved since the implementation of these interventions, it is unclear whether these BP changes can be generalized to diverse and high-risk populations. This report describes the 4-decade change in BP levels for the population in a high disease risk southeastern region of the United States. The objective is to determine the magnitude of the shift in systolic BP (SBP) among Blacks and Whites from the Southeast between 1960 and 2005 with the assessment of the unique population cohorts. Methods: A multicohort study design compared BPs from the CHS (Charleston Heart Study) and ECHS (Evans County Heart Study) in 1960 and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) 4 decades later. The analyses included participants ≥45 years of age from CHS (n=1323), ECHS (n=1842), and REGARDS (n=6294) with the main outcome of SBP distribution. Results: Among Whites 45 to 54 years of age, the median SBP was 18 mm Hg (95% CI, 16–21 mm Hg) lower in 2005 than 1960. The median shift was a 45 mm Hg (95% CI, 37–51 mm Hg) decline for those ≥75 years of age. The shift was larger for Blacks, with median declines of 38 mm Hg (95% CI, 32–40 mm Hg) at 45 to 54 years of age and 50 mm Hg (95% CI, 33–60 mm Hg) for ages ≥75 years. The 95th percentile of SBP decreased 60 mm Hg for Whites and 70 mm Hg for Blacks. Conclusions: The results of the current analyses of the unique cohorts in the Southeast confirm the improvements in population SBP levels since 1960. This assessment provides new evidence of improvement in SBP, suggesting that strategies and programs implemented to improve hypertension treatment and control have been extraordinarily successful for both Blacks and Whites residing in a high-risk region of the United States. Severe BP elevations commonly observed in the 1960s have been nearly eliminated, with the current 75th percentile of BP generally less than the 25th percentile of BP in 1960.

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