Racial Disparities in Hypertensive Cardiovascular Disease and Chronic Kidney Disease

Abstract

Epidemiologic studies have shown that hypertension (HTN) and its cardiovascular (CV) complications, carry significantly higher morbidity and mortality in African‐Americans (AA) compared with Caucasians. These observations may be partly explained by a higher prevalence of cardiovascular disease (CVD) risk factors, such as HTN, diabetes, and tobacco use among AA.Chronic Kidney Disease (CKD) is not only a major risk factor for End‐Stage Renal Disease, but is a predictor of CVD and death. CVD mortality rates are 10‐fold greater in individuals with CKD. Blacks are disproportionately affected by hypertensive CKD with a 7‐fold higher incidence. Additional risk factors for progressive CKD include level of blood pressure control, proteinuria, low income, and genetic influences.Microalbuminuria and CKD are well‐established risk factors for CV mortality in both diabetic and non‐diabetics and is directly associated with left ventricular hypertrophy and coronary heart disease. The prevalence of microalbuminuria is higher among diabetics and hypertensives as well as among AA compared to Whites.In summary, African‐Americans have a higher burden of HTN, diabetes, CVD and of CKD. However, the pathophysiologic processes underlying this racial predisposition have not been fully elucidated.