Hypertension in Blacks: Individualized Therapy Based on Renin/Aldosterone Phenotyping.

Abstract

The prevalence of hypertension in blacks is higher than in other groups. The following is quoted from the 2015 statistical report of the American Heart Association1: “In 2009 to 2012, the age-adjusted prevalence of hypertension was 44.9% and 46.1% among non-Hispanic black men and women, respectively; 32.9% and 30.1% among non-Hispanic white men and women, respectively; and 29.6% and 29.9% among Hispanic men and women, respectively.” In the national REGARDS cohort (Reasons for Geographic and Racial Differences in Stroke)2, among 27 744 participants followed up for 4.4 years (2003–2010), the overall age- and sex-adjusted black/white incidence rate ratio for ischemic stroke was 1.51, but for ages 45 to 54 years, it was 4.02, whereas for those ≥85 years of age, it was 0.86. This suggests that those who survived to 85 years of age did not have resistant hypertension. Among blacks, compared with whites, the relative risk of intracranial atherosclerotic stroke was 5.85; of extracranial atherosclerotic stroke, 3.18; of lacunar stroke, 3.09; and of cardioembolic stroke, 1.58.3 Similarly, Markus et al4 reported that in South London, United Kingdom, the relative risk of stroke because of small vessel disease in black patients was 2.94 (95% confidence interval, 1.97–4.39; P 20 years of age, the age-adjusted relative risk of intracerebral hemorrhage among blacks compared with white patients was 2.4 for men and 3.2 for women.5 In the Northern Kentucky study, “The greatest excess risk of ICH in blacks compared with whites was found among young to middle-aged (35 to 54 years) persons with brain stem (RR, 9.8; 95% CI, 4.2 to 23.0) and deep cerebral (RR, 4.5; 95% CI, 3.0 to 6.8) hemorrhage.”6 Strokes due to small vessel disease …