Ethnicity and blood pressure

Abstract

The prevalence, impact, and control of hypertension differ across racial and ethnic subgroups in the United States population. Whether race/ethnicity should be a significant consideration in the choice of individual antihypertensive drugs continues to be a topic of intense interest and debate. This brief review will discuss recent findings that bear on the management of hypertension in these special patient groups.

Figure 1

Hypertension prevalence and control rates in 1999–2000 by age and racelethnicity in men and women. Error bars indicate 95% confidence intervals. Data are weighted to the United States population. For comparisons between racial/ethnic groups (with non‐Hispanic whites as the referent), p values are as follows: for Mexican Americans, men aged 40–59 years, p<0.001; men aged at least 60 years, p=0.003; women aged 40–59 years, p=0.002; and women aged at least 60 years, p=0.04; for non‐Hispanic blacks, men aged 40–59 years, p=0.02; men aged at least 60 years, p=0.51; women aged 40–59 years, p=0.003; and women aged at least 60 years, p=0.98. Reproduced with permission from JAMA. 2003–290:199–206. Copyright 2003, American Medical Association. All rights reserved.

Figure 2

Prevalence of hypertension in women and treatment status by race/ethnicity in the Women's Health Initiative (WHI). Adapted with permission from Wassertheil‐Smoller S, Anderson G, Pasty BN, et al. Hypertension and its treatment in postmenopausal women: baseline data from the Women's Health Initiative. Hypertension. 2000;36(5):780–789.

Figure 3

Predictors of blood pressure control and intensity of antihypertensive drug treatment in diverse North American settings (Antihypertensive and Lipid Lowering to Prevent Heart Attack Trial [ALLHAT]). Multiple logistic analysis: relative odds (95% confidence interval) of being on two or more drugs at 36 months. SBP=systolic blood pressure; ASCVD=arteriosclerotic cardiovascular disease; BMI=body mass index; Rx=treatment; Cr=creatinine; ECG=electrocardiogram; LVH=left ventricular hypertrophy; BP=blood pressure. Data derived from J Clin Hypertens (Greenwich). 2002;4:393–404.

Figure 4

Relative risks and 95% confidence intervals for amlodipine/chlorthalidone and lisinopril/chlorthalidone subgroup comparisons in blacks and nonblacks: the Antihypertensive and Lipid Lowering to Prevent Heart Attack Trial (ALLHAT). MI=myocardial infarction; CHD=coronary heart disease; CVD=cardiovascular disease. Data derived from JAMA. 2002;288:2981–2997. Copyright 2002, American Medical Association. All rights reserved.

Figure 5

Results of primary composite end point in the Losartan Intervention For Endpoint Reduction (LIFE) study by ethnic group. A) Results of primary composite end point by ethnic group. The dots represent the hazard ratio; dot size is proportional to the number of patients for each ethnic group, as shown to the left. The line through each dot corresponds to the 95% confidence interval. B) Results of primary composite end point by ethnic group in the United States: blacks vs. nonblacks. Reproduced from Julius S, Alderman MH, Beevers G, et al. The LIFE study. J Am Coll Cardiol. 2004;43:1047–1055. Copyright 2004, with permission from American College of Cardiology Foundation.