Hypertension‐Related Morbidity and Mortality in African Americans—Why We Need to Do Better

Ferdinand, Keith C.; Sounders, Elijah

doi:10.1111/j.1524-6175.2006.05295.x

Cited by 50 publications

(47 citation statements)

References 89 publications

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“…For instance, there is a higher prevalence and earlier onset of hypertension among blacks than whites (Ferdinand and Saunders, 2006). Blacks are also almost twice as likely to have diabetes than non-Hispanic whites (Centers for Disease Control, 2007).…”

Section: Introductionmentioning

confidence: 99%

Whites have a more robust hypothalamic–pituitary–adrenal axis response to a psychological stressor than blacks

Chong¹,

Uhart²,

McCaul³

et al. 2008

Psychoneuroendocrinology

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SummaryObjective-Differences in the hypothalamic-pituitary-adrenal (HPA) axis response to stress may confer differences in susceptibility to a variety of diseases. We hypothesized that whites would differ from blacks in HPA axis response to a psychological stressor.Design-Healthy subjects aged 18-30 were recruited from Baltimore, Maryland. At initial assessment, they completed psychometric tests measuring anxiety, mood, and personality. Subjects then participated in the Trier Social Stress Test (TSST), which consisted of 10 min of public speaking and mental arithmetic exercises. Subjective anxiety was measured immediately pre-and post-TSST. Race effects on cortisol, adrenocorticotrophin (ACTH), and prolactin responses to the TSST were analyzed by GEE longitudinal analysis methods. The analysis controlled for gender, baseline hormone levels, socioeconomic factors, anxiety, mood, and dimensions of personality.Results-Ninety-eight subjects participated in the TSST. Whites had 36% greater relative mean cortisol response than blacks (95% CI: 10%-67%, P = 0.004). Whites had significantly higher mean ACTH compared to blacks at 25 min after the start of the TSST, (35%, 95% CI: 16%-58% greater, P < 0.001). There was no difference in prolactin response. Of note, whites and blacks did not differ in subjective anxiety response to the TSST.Conclusions-In sum, we found that whites have a more robust HPA axis response to the TSST compared with blacks, even after controlling for several socioeconomic and psychological factors. In contrast, we observed no difference in prolactin response. There were no differences in subjective response to the TSST to explain the difference in HPA axis response. Further study is indicated to explain this finding and to test whether it can be extrapolated to other forms of stress.

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Section: Introductionmentioning

confidence: 99%

Whites have a more robust hypothalamic–pituitary–adrenal axis response to a psychological stressor than blacks

Chong¹,

Uhart²,

McCaul³

et al. 2008

Psychoneuroendocrinology

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“…On the other hand, Blacks in general are more insulin resistant than are Whites. 24,25 They are also more prone to hypertension 26 and to diabetes. 27,28 Thus, any protective effect of less dyslipidemia among US Blacks probably is negated by a higher frequency of other metabolic risk factors, notably insulin resistance, hypertension, and diabetes.…”

Section: Black Americansmentioning

confidence: 99%

Metabolic Syndrome Pandemic

Grundy

2008

ATVB

1,262

877

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The metabolic syndrome is a multiplex risk factor that consists of several risk correlates of metabolic origin. In addition, to dyslipidemia, hypertension, and hyperglycermia, the syndrome carries a prothrombotic state and a proinflammatory state. Persons with the metabolic syndrome are at essentially twice the risk for cardiovascular disease compared with those without the syndrome. It further raises the risk for type 2 diabetes by about 5-fold. Although some investigators favor keeping risk factors separate for purposes of clinical management, others believe that identifying individuals with an aggregation of risk factors provides additional useful information to guide clinical management. In particular it focuses attention on obesity and sedentary life habits that are the root of the syndrome. This review addresses the prevalence of this clustering phenomenon throughout the world. Such seems appropriate because of the increasing prevalence of obesity in almost all countries. The available evidence indicates that in most countries between 20% and 30% of the adult population can be characterized as having the metabolic syndrome. In some populations or segments of the population, the prevalence is even higher. On the other hand, in parts of developing world in which young adults predominate, the prevalence is lower; but with increasing affluence and aging of the population, the prevalence undoubtedly with rise.

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“…2 In African Americans, clinical evidence suggests a decreased response to monotherapy with agents that act on the RAAS and this is speculated to be related to increased sodium intake, volume expansion, and low plasma renin activity in this population compared with whites. 2,[12][13][14][15] Addition of a thiazide diuretic or calcium channel blocker (CCB), however, ameliorates or removes any racial differences in BP response with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and b-blockers. 16,17 Aliskiren is the first-available direct renin inhibitor [18][19][20] that acts at the rate-limiting step of angiotensin (Ang) II synthesis, inhibiting the conversion of angiotensinogen to Ang I and, unlike ACE inhibitors or ARBs, does not cause a compensatory increase in plasma renin activity (PRA).…”

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confidence: 99%

Peripheral and Central Blood Pressure Responses of Combination Aliskiren/Hydrochlorothiazide and Amlodipine Monotherapy in African American Patients With Stage 2 Hypertension: The ATLAAST Trial

Ferdinand

Pool

Weitzman

et al. 2011

J of Clinical Hypertension

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Efficacy of antihypertensive agents on central blood pressure (BP) in African Americans is not well studied. The authors report on an 8-week double-blind, randomized study of African American patients with stage 2 hypertension that compared brachial and central BP responses (substudy of 53 patients) to combination aliskiren ⁄ hydrochlorthiazide (HCTZ) and amlodipine monotherapy. Following a 1-to 4-week washout, initial therapy was aliskiren ⁄ HCTZ 150 ⁄ 12.5 mg (n=166) or amlodipine 5 mg (n=166) for 1 week, forced-titrated to aliskiren ⁄ HCTZ 300 ⁄ 25 mg or amlodipine 10 mg for 7 weeks. Mean seated systolic BP reductions from baseline was similar with both treatments ()28.6 mm Hg with aliskiren ⁄ HCTZ vs )28.2 mm Hg with amlodipine). In the substudy, significantly greater reductions in central systolic BP was observed with aliskiren ⁄ HCTZ vs amlodipine ()30.1 mm Hg vs )21.2; P=.031), although 24-hour mean ambulatory BP reductions between the two groups were similar. Central pressure is considered an important risk factor in African Americans, and these findings may suggest a new treatment option for these patients. J Clin Hypertens (Greenwich). 2011;13:366-375. Ó2011 Wiley Periodicals, Inc.African American adults have a greater prevalence of hypertension, an earlier onset, greater pressure-related end organ damage, and low blood pressure (BP) control rates compared with their white American counterparts (32% vs 23%).1,2 In addition, African Americans have diffuse macrovascular and microvascular dysfunction manifesting as increased stiffness of the carotid artery and aorta, 3,4 heightened-resistance artery constriction, and blunted-resistance artery dilation, 5 all of which correlate directly with end organ damage. 6,7 Although the prognostic value of brachial BP for future cardiovascular events has been well established, arterial stiffness and microvascular dysfunction significantly influence central BP, while brachial pressure is less influenced by these changes. 8The findings from the Strong Heart Study, which noninvasively determined central pulse pressure is more strongly related to vascular hypertrophy, extent of atherosclerosis, and cardiovascular events than is brachial BP, support the use of central pressure as a treatment target in clinical trials. 9 To date, findings from at least 7 longitudinal studies show that central BP is a stronger predictor of cardiovascular outcomes than brachial pulse pressure. 8,10 Although prospective data are needed, central BP may be pathophysiologically more relevant than peripheral (brachial) BP in the pathogenesis of cardiovascular disease.8 A recent study conducted in young (mean age, 21.7 years) and healthy (normotensive) African American and white men (mean age, 23.6 years) reported higher central BP and stiffer blood vessels in African American men compared with their white counterparts, signs that African American men are developing hypertension early and with few symptoms. 11Calcium channel antagonists and diuretics have long been preferred as an antihypertensive...

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Hypertension‐Related Morbidity and Mortality in African Americans—Why We Need to Do Better

Cited by 50 publications

References 89 publications

Whites have a more robust hypothalamic–pituitary–adrenal axis response to a psychological stressor than blacks

Whites have a more robust hypothalamic–pituitary–adrenal axis response to a psychological stressor than blacks

Metabolic Syndrome Pandemic

Peripheral and Central Blood Pressure Responses of Combination Aliskiren/Hydrochlorothiazide and Amlodipine Monotherapy in African American Patients With Stage 2 Hypertension: The ATLAAST Trial

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