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Hypertensive complications in blacks

Brent M Egan, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc


Hypertension in blacks as compared with whites tends to be more common, to present earlier in life, and to be more severe (figure 1) [1]. In addition, progression from prehypertension to hypertension is accelerated in blacks [2]. The reasons for these observations are incompletely understood, as the relative importance of environmental and genetic factors has not been established [3,4]. The treatment of hypertension is discussed separately. (See "Treatment of hypertension in blacks".)

Important risk factors for hypertension among blacks include:

Lower socioeconomic status

Ingestion of a high-sodium/low-potassium diet

Another possible mechanism, which is also related to lower socioeconomic class, is poor maternal nutrition leading to low birth weight in the infant. Low birth weight has been associated with an increased risk of hypertension in adulthood, perhaps due in part to impaired renal growth [5]. An associated reduction in renal development with fewer functioning nephrons may contribute to the predisposition to the development of end-stage renal disease (ESRD) [5], including ESRD occurring before the age of 50 years, in African Americans [6]. (See "Possible role of low birth weight in the pathogenesis of primary (essential) hypertension".)

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Literature review current through: Sep 2017. | This topic last updated: Dec 05, 2016.
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  1. Carson AP, Howard G, Burke GL, et al. Ethnic differences in hypertension incidence among middle-aged and older adults: the multi-ethnic study of atherosclerosis. Hypertension 2011; 57:1101.
  2. Selassie A, Wagner CS, Laken ML, et al. Progression is accelerated from prehypertension to hypertension in blacks. Hypertension 2011; 58:579.
  3. McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of medicare coverage. Ann Intern Med 2009; 150:505.
  4. Berenson GS, Chen W, Dasmahapatra P, et al. Stimulus response of blood pressure in black and white young individuals helps explain racial divergence in adult cardiovascular disease: the Bogalusa Heart Study. J Am Soc Hypertens 2011; 5:230.
  5. Lopes AA, Port FK. The low birth weight hypothesis as a plausible explanation for the black/white differences in hypertension, non-insulin-dependent diabetes, and end-stage renal disease. Am J Kidney Dis 1995; 25:350.
  6. Lackland DT, Bendall HE, Osmond C, et al. Low birth weights contribute to high rates of early-onset chronic renal failure in the Southeastern United States. Arch Intern Med 2000; 160:1472.
  7. Cooper R, Rotimi C. Hypertension in blacks. Am J Hypertens 1997; 10:804.
  8. Howard G, Lackland DT, Kleindorfer DO, et al. Racial differences in the impact of elevated systolic blood pressure on stroke risk. JAMA Intern Med 2013; 173:46.
  9. Five-year findings of the hypertension detection and follow-up program. III. Reduction in stroke incidence among persons with high blood pressure. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1982; 247:633.
  10. Bergman S, Key BO, Kirk KA, et al. Kidney disease in the first-degree relatives of African-Americans with hypertensive end-stage renal disease. Am J Kidney Dis 1996; 27:341.
  11. Feldman HI, Klag MJ, Chiapella AP, Whelton PK. End-stage renal disease in US minority groups. Am J Kidney Dis 1992; 19:397.
  12. Ooi WL, Budner NS, Cohen H, et al. Impact of race on treatment response and cardiovascular disease among hypertensives. Hypertension 1989; 14:227.
  13. Otten MW Jr, Teutsch SM, Williamson DF, Marks JS. The effect of known risk factors on the excess mortality of black adults in the United States. JAMA 1990; 263:845.
  14. Prather AA, Blumenthal JA, Hinderliter AL, Sherwood A. Ethnic differences in the effects of the DASH diet on nocturnal blood pressure dipping in individuals with high blood pressure. Am J Hypertens 2011; 24:1338.
  15. Hebert LA, Agarwal G, Ladson-Wofford SE, et al. Nocturnal blood pressure in treated hypertensive African Americans Compared to treated hypertensive European Americans. J Am Soc Nephrol 1996; 7:2130.
  16. Hedayati SS, Minhajuddin AT, Ijaz A, et al. Association of urinary sodium/potassium ratio with blood pressure: sex and racial differences. Clin J Am Soc Nephrol 2012; 7:315.
  17. Frisancho AR, Leonard WR, Bollettino LA. Blood pressure in blacks and whites and its relationship to dietary sodium and potassium intake. J Chronic Dis 1984; 37:515.
  18. Aviv A, Hollenberg NK, Weder AB. Sodium glomerulopathy: tubuloglomerular feedback and renal injury in African Americans. Kidney Int 2004; 65:361.
  19. Aviv A, Hollenberg NK, Weder A. Urinary potassium excretion and sodium sensitivity in blacks. Hypertension 2004; 43:707.
  20. Haffner SM, Mitchell BD, Valdez RA, et al. Eight-year incidence of hypertension in Mexican-Americans and non-Hispanic whites. The San Antonio Heart Study. Am J Hypertens 1992; 5:147.
  21. Kizer JR, Arnett DK, Bella JN, et al. Differences in left ventricular structure between black and white hypertensive adults: the Hypertension Genetic Epidemiology Network study. Hypertension 2004; 43:1182.
  22. Rostand SG, Brown G, Kirk KA, et al. Renal insufficiency in treated essential hypertension. N Engl J Med 1989; 320:684.
  23. Li S, McAlpine DD, Liu J, et al. Differences between blacks and whites in the incidence of end-stage renal disease and associated risk factors. Adv Ren Replace Ther 2004; 11:5.
  24. Kopp JB, Smith MW, Nelson GW, et al. MYH9 is a major-effect risk gene for focal segmental glomerulosclerosis. Nat Genet 2008; 40:1175.
  25. Kao WH, Klag MJ, Meoni LA, et al. MYH9 is associated with nondiabetic end-stage renal disease in African Americans. Nat Genet 2008; 40:1185.
  26. Parsa A, Kao WH, Xie D, et al. APOL1 risk variants, race, and progression of chronic kidney disease. N Engl J Med 2013; 369:2183.
  27. Genovese G, Friedman DJ, Ross MD, et al. Association of trypanolytic ApoL1 variants with kidney disease in African Americans. Science 2010; 329:841.
  28. Genovese G, Tonna SJ, Knob AU, et al. A risk allele for focal segmental glomerulosclerosis in African Americans is located within a region containing APOL1 and MYH9. Kidney Int 2010; 78:698.
  29. Friedman DJ, Pollak MR. Genetics of kidney failure and the evolving story of APOL1. J Clin Invest 2011; 121:3367.
  30. Parmer RJ, Stone RA, Cervenka JH. Renal hemodynamics in essential hypertension. Racial differences in response to changes in dietary sodium. Hypertension 1994; 24:752.
  31. Textor SC, Gloviczki ML, Flessner MF, et al. Association of filtered sodium load with medullary volumes and medullary hypoxia in hypertensive African Americans as compared with whites. Am J Kidney Dis 2012; 59:229.
  32. SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015; 373:2103.
  33. Agodoa LY, Appel L, Bakris GL, et al. Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA 2001; 285:2719.
  34. Fogo A, Breyer JA, Smith MC, et al. Accuracy of the diagnosis of hypertensive nephrosclerosis in African Americans: a report from the African American Study of Kidney Disease (AASK) Trial. AASK Pilot Study Investigators. Kidney Int 1997; 51:244.
  35. Flack JM, Sica DA, Bakris G, et al. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension 2010; 56:780.
  36. Wright JT Jr, Agodoa LY, Appel L, et al. New recommendations for treating hypertension in black patients: evidence and/or consensus? Hypertension 2010; 56:801.
  37. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311:507.