OBJECTIVES: This study was undertaken to describe the distribution of blood pressures, hypertension prevalence, and associated risk factors among seven populations of West African origin. METHODS: The rates of hypertension in West Africa (Nigeria and Cameroon), the Caribbean (Jamaica, St. Lucia, Barbados), and the United States (metropolitan Chicago, Illinois) were compared on the basis of a highly standardized collaborative protocol. After researchers were given central training in survey methods, population-based samples of 800 to 2500 adults over the age of 25 were examined in seven sites, yielding a total sample of 10014. RESULTS: A consistent gradient of hypertension prevalence was observed, rising from 16% in West Africa to 26% in the Caribbean and 33% in the United States. Mean blood pressures were similar among persons aged 25 to 34, while the increase in hypertension prevalence with age was twice as steep in the United States as in Africa. Environmental factors, most notably obesity and the intake of sodium and potassium, varied consistently with disease prevalence across regions. CONCLUSION: The findings demonstrate the determining role of social conditions in the evolution of hypertension risk in these populations.

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O B J E C T I V E -Prior studies have supported that waist circ u m f e rence correlates better with visceral adipose tissue and is a better predictor of cardiovascular disease than are BMI and waist-to-hip ratio. In this study, we reexamine the role of waist size on the risk of hypert e n s i o n and type 2 diabetes in African-origin populations from three contrasting enviro n m e n t s . RESEARCH DESIGN AND METHODS-A cross-sectional survey was conducted of 5,042 men and women 25-74 years of age from Nigeria, Jamaica, and the U.S. The re l a t i o nship between waist, blood pre s s u re, and fasting blood glucose was assessed using multiple linear re g ression analyses. Logistic re g ression analyses using sex-specific empirical waist cut-points were used to determine the risks of hypertension and type 2 diabetes. R E S U LT S -Waist circ u m f e rence was positively correlated with blood pre s s u re and fasting blood glucose (P 0 . 0 5 ). I n c reasing waist quartiles were significantly associated with higher risks of hypertension in the three populations, as estimated from age-adjusted odds ratios obtained from sex-specific logistic re g ression models. A highly elevated risk of type 2 diabetes-10-fold for Jamaican men and 23-fold for African-American women-was observed in the comparison of lowest to highest quartiles of waist circ u m f e re n c e C O N C L U S I O N S -Substantial reduction in hypertension and diabetes in men and women is achievable if the waist size is decreased in these populations. Intervention pro g r a m s designed to reduce waist circ u m f e rence through lifestyle modification, including exercise and diet, may have significant public health significance in reducing the incidence of hypert e n s i o n and adult-onset diabetes in these populations.

The incidence of type 2 diabetes is growing rapidly, not only in developed countries but also worldwide. We chose to study type 2 diabetes in West Africa, where diabetes is less common than in the U.

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