Hypertension in ethnic groups: epidemiological and clinical perspectives

Abstract

In the UK and other developed nations, hypertension and its vascular complications are more common in ethnically African and South-Asian communities compared with Europeans. While these conditions are less common in rural India and Africa, they present a rising problem in expanding cities in all developing countries. Hypertension is, therefore, mainly related to environmental and lifestyle factors rather than genetically determined racial differences. Studies in the USA and elsewhere show that the striking differences in the prevalence of hypertension between people of African and European origin are greatly reduced after adjustment for socio-economic status. One important and probably genuine racial difference between ethnic groups is the significantly suppressed activity of the renin-angiotensin-aldosterone system in African-origin hypertensive patients. As a consequence of this, they are rather more sensitive to a low-salt diet but significantly less sensitive to drugs that block the renin-angiotensin-aldosterone system (angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers) and beta-blockers. There is also evidence that renin suppression is common in Japanese and Chinese hypertensive patients as well, although no direct comparisons between these two groups with European-origin patients have been carried out. The management and control of hypertension is unsatisfactory in all ethnic groups and all nations. No one group needs particular targeting; all need better quality systematic care.

Depressive Symptoms and 24-Hour Ambulatory Blood Pressure in Africans: The SABPA Study

“…Black Africans are known to have elevated BP compared with Caucasians [20], and this was confirmed in the present study. Black participants from the present study also demonstrated a higher prevalence of depressive symptoms.…”

Prevalence, awareness, treatment and control of hypertension among slum dwellers in Nairobi, Kenya

“…There is limited literature published on ethnic differences in hypertension in this setting but there is substantial literature on the ethnic differences in the prevalence of hypertension elsewhere [47]. The different lifestyles, including occupation, diet, and sedentary behavior may be the most plausible explanation for these significant differences, although genetic factors may have a role to play [48].…”

Use of dihydropyridine calcium channel blockers in the management of hypertension in Eastern Asians: A scientific statement from the Asian Pacific Heart Association

“…First, CCBs are probably more effective in lowering blood pressure in Eastern Asians, because, when compared with the White population, Eastern Asians have high dietary intakes of sodium 5 and are more likely to be salt sensitive. 6 Second, CCBs, compared with other classes of antihypertensive drugs, provide more protection against stroke; 7,8 hence, they are more relevant because the major complication of hypertension in Eastern Asians is stroke rather than myocardial infarction. In the recent Chinese FEVER trial, the incidence of stroke and coronary events was 15.9 and 6.2 per 1000 patientyears, respectively.…”