Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management

Abstract

The United Kingdom is a diverse society with 7.9% of the population from black and minority ethnic groups (BMEGs). The causes of the excess cardiovascular disease (CVD) and stroke morbidity and mortality in BMEGs are incompletely understood though socio-economic factors are important. However, the role of classical cardiovascular (CV) risk factors is clearly important despite the patterns of these risk factors varying significantly by ethnic group. Despite the major burden of CVD and stroke among BMEGs in the UK, the majority of the evidence on the management of such conditions has been based on predominantly white European populations. Moreover, the CV epidemiology of African Americans does not represent well the morbidity and mortality experience seen in black Africans and black Caribbeans, both in Britain and in their native African countries. In particular, atherosclerotic disease and coronary heart disease are still relatively rare in the latter groups. This is unlike the South Asian diaspora, who have prevalence rates of CVD in epidemic proportions both in the diaspora and on the subcontinent. As the BMEGs have been under-represented in research, a multitude of guidelines exists for the 'general population.' However, specific reference and recommendation on primary and secondary prevention guidelines in relation to ethnic groups is extremely limited. This document provides an overview of ethnicity and CVD in the United Kingdom, with management recommendations based on a roundtable discussion of a multidisciplinary ethnicity and CVD consensus group, all of whom have an academic interest and clinical practice in a multiethnic community.

The 2007 revised ESC/ESH Guidelines in the management of hypertension: clarifying individual patient care

“…Their situation must be part of a community wide care plan and it must relate to their circumstances and responsiveness. 2 This major omission requires attention in the next statement.…”

Factors associated with hypertension awareness, treatment and control in rural Chinese

“…1,2 Establishing factors associated with awareness and management is an essential starting point in preventing increasing burden of morbidity and mortality from hypertension-related cardiovascular diseases. [3][4][5] However, in China, especially in rural China where resource setting is poorer than the urban, information on factors associated with awareness, treatment and control of hypertension is very scarce despite increasing prevalence of hypertension.…”

Antihypertensive drugs in combination: additive or greater than additive?

“…7 Young and white individuals tend to have high plasma renin activity and respond well to drugs that block the renin-angiotensin system (RAS), ACE inhibitors or angiotensin receptor blockers (A) and b-blockers (B), while older people and black subjects of all ages tend to have low renin hypertension and respond preferentially to CCBs (C) and diuretics (D). [6][7][8][9][10] This is the rationale for the A (B) CD algorithm proposed by the British Hypertension Society. 6 The heterogeneity of the response to antihypertensive therapy means that responses in individuals and the identification of factors that determine response require withinpatient (crossover) comparisons.…”