Skip to main content

Advertisement

SpringerLink
Log in

The Role of Hypertension in Race-Ethnic Disparities in Cardiovascular Disease

  • Race + Ethnicity Disparities (K Watson and T Horwich, Section Editors)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Race-ethnic disparities in cardiovascular disease (CVD) have persisted in the USA over the past few decades. Hypertension (HTN) is a significant contributor to CVD, including coronary heart disease, stroke, end-stage kidney disease and overall mortality and race-ethnic disparities in longevity. Additionally, both non-Hispanic blacks (NHBs) and Hispanic adults have been known to have higher prevalence of poorly controlled blood pressure compared to non-Hispanic whites (NHWs). Addressing these disparities has been a focus of programs such as the Million Hearts initiative. This review will provide an update of available data on HTN in various race-ethnic groups, including awareness, treatment, and control and note the recent progress in HTN control across all race/ethnic groups. We will also discuss the recent 2014 U.S. HTN guideline that has led to debate regarding the potential impact of BP goals in older persons on worsening CVD disparities, with disproportionate effects on women and NHBs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–e292. This article from the American Heart Association provides the most recent epidemiological data regarding CVD in the US.

    Article  PubMed  Google Scholar 

  2. Centers for Disease Control and Prevention (CDC). Health disparities and inequalities report—United States. MMWR Morb Mortal Wkly Rep. 2013;62 Suppl 3:157–60.

    Google Scholar 

  3. Fang J, Yang Q, Hong Y, Loustalot F. Status of cardiovascular health among adult Americans in the 50 States and the District of Columbia, 2009. J Am Heart Assoc. 2012;1(6):e005371. This article provides a recent update on the status of cardiovascular health metrics in the US.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Hozawa A, Folsom AR, Sharrett AR, Chambless LE. Absolute and attributable risks of cardiovascular disease incidence in relation to optimal and borderline risk factors: comparison of African American with white subjects—atherosclerosis risk in communities study. Arch Intern Med. 2007;167(6):573–9.

    Article  PubMed  Google Scholar 

  5. Centers for Disease Control and Prevention (CDC). Racial/ethnic and socioeconomic disparities in multiple risk factors for heart disease and stroke—United States, 2003. MMWR Morb Mortal Wkly Rep. 2005;54(5):113–7.

    Google Scholar 

  6. Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6(4):e1000058.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011–2012. NCHS Data Brief. 2013 Oct. This article provides a recent update on the prevalence of hypertension (HTN), along with awareness, treatment, and control among various race-ethnic groups in the US.

  8. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for US adults: national health interview survey, 2012. Vital Health Stat. 2014;10.

  9. Kramer H, Han C, Post W, Goff D, Diez-Roux A, Cooper R, et al. Racial/ethnic differences in hypertension and hypertension treatment and control in the multi-ethnic study of atherosclerosis (MESA). Am J Hypertens. 2004;17(10):963–70.

    Article  PubMed  Google Scholar 

  10. Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC, et al. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation. 2014;130(7):593–625. This article provides an recent update on the CVD status of Hispanics/Latinos in the US along with an comprehensive review on psychosocial determinants of health as it pertains to Hispanics/Latinos in the US.

    Article  PubMed  Google Scholar 

  11. Sorlie PD, Allison MA, Avilés-Santa ML, Cai J, Daviglus ML, Howard AG, et al. Prevalence of hypertension, awareness, treatment, and control in the Hispanic community health study/study of Latinos. Am J Hypertens. 2014;27(6):793–800. This article provides recent data on HTN among Hispanics/Latinos from the Hispanic Communities Health Study-Study of Latinos (HCHS/SOL), currently the largest cohort study of CVD in US Hispanics.

    Article  PubMed  Google Scholar 

  12. Hertz RP, Unger AN, Cornell JA, Saunders E. Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med. 2005;165(18):2098–104.

    Article  PubMed  Google Scholar 

  13. Centers for Disease Control and Prevention (CDC). Racial/Ethnic disparities in the awareness, treatment, and control of hypertension—United States, 2003–2010. MMWR Morb Mortal Wkly Rep. 2013;62(18):351–5.

    Google Scholar 

  14. Romero CX, Romero TE, Shlay JC, Ogden LG, Dabelea D. Changing trends in the prevalence and disparities of obesity and other cardiovascular disease risk factors in three racial/ethnic groups of USA adults. Adv Prev Med. 2012

  15. Carson AP, Howard G, Burke GL, Shea S, Levitan EB, Muntner P. Ethnic differences in hypertension incidence among middle-aged and older adults: the multi-ethnic study of atherosclerosis. Hypertension. 2011;57(6):1101–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Selassie A, Wagner CS, Laken ML, Ferguson ML, Ferdinand KC, Egan BM. Progression is accelerated from prehypertension to hypertension in blacks. Hypertension. 2011;58(4):579–87.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Chobanian Aram V et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.

    Article  CAS  PubMed  Google Scholar 

  18. Yoon SS, Burt V, Louis T, Carroll MD. Hypertension among adults in the United States, 2009–2010. NCHS Data Brief. 2012 Oct.

  19. Howard G, Prineas R, Moy C, Cushman M, Kellum M, Temple E, et al. Racial and geographic differences in awareness, treatment, and control of hypertension: the REasons for Geographic and Racial Differences in Stroke study. Stroke. 2006;37(5):1171–8.

    Article  PubMed  Google Scholar 

  20. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303(20):2043–50.

    Article  CAS  PubMed  Google Scholar 

  21. Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC. Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation. 2011;124(9):1046–58.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Egan BM, Li J, Hutchison FN, Ferdinand KC. Hypertension in the United States, 1999 to 2012: progress toward healthy people 2020 goals. Circulation. 2014;130(19):1692–9. This articles provides a recent update on HTN prevalence among race-ethnic groups and current status with respect to Health People 2020 established goals.

    Article  PubMed  Google Scholar 

  23. Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep. 2013;61(4):1–117.

    PubMed  Google Scholar 

  24. Centers for Disease Control and Prevention (CDC). Vital signs: avoidable deaths from heart disease, stroke, and hypertensive disease—United States, 2001–2010. MMWR Morb Mortal Wkly Rep. 2013;62(35):721–7.

    Google Scholar 

  25. Centers for Disease Control and Prevention (CDC). Hypertension-related mortality among Hispanic subpopulations—United States, 1995–2002. MMWR Morb Mortal Wkly Rep. 2006;55(7):177–80.

    Google Scholar 

  26. Chen J, Normand S-LT, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998–2008. JAMA : the journal of the American Medical Association. 2011;306(15):1669–78.

    Article  CAS  Google Scholar 

  27. Ferdinand KC, Elkayam U, Mancini D, Ofili E, Piña I, Anand I, et al. Use of isosorbide dinitrate and hydralazine in African-Americans with heart failure 9 years after the African-American Heart Failure Trial. Am J Cardiol. 2014;114(1):151–9. This article provides a review on the management of heart failure, particularly in African Americans.

    Article  CAS  PubMed  Google Scholar 

  28. Kalinowski L, Dobrucki IT, Malinski T. Race-specific differences in endothelial function: predisposition of African Americans to vascular diseases. Circulation. 2004;109:2511e2517.

    Article  Google Scholar 

  29. Nesbitt S, Victor RG. Pathogenesis of hypertension in African Americans. Congest Heart Fail. 2004;10:24e29.

    Article  Google Scholar 

  30. Richardson AD, Piepho RW. Effect of race on hypertension and antihypertensive therapy. Int J Clin Pharmacol Ther. 2000;38:75e79.

    Article  Google Scholar 

  31. Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D’Agostino RB, Kannel WB, et al. Framingham Heart Study. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106:3068–72.

    Article  PubMed  Google Scholar 

  32. Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D, Dzudie A, Kouam CK, Suliman A, Schrueder N, Yonga G, Ba SA, Maru F, Alemayehu B, Edwards C, Davison BA, Cotter G, Sliwa K. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries: results of the Sub-Saharan Africa Survey of Heart Failure. Arch Intern Med 2012:1e9

  33. Bahrami H, Kronmal R, et al. Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis. Arch Intern Med. 2008;168(19):2138–45.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Kalogeropoulos A, Georgiopoulou V, Kritchevsky SB, Psaty BM, Smith NL, Newman AB, et al. Epidemiology of incident heart failure in a contemporary elderly cohort: the health, aging, and body composition study. Arch Intern Med. 2009;169(7):708–15.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606–19. This article provides estimates on the future incidence of heart failure in the US from the AHA.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Cruz-Flores S, Rabinstein A, Biller J, Elkind MS, Griffith P, Gorelick PB, et al. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:2091–116.

    Article  PubMed  Google Scholar 

  37. Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MS, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2014 Oct 28. This article is the most recent guideline on the prevention of stroke from the AHA/American Stroke Association.

  38. Rosamond WD, Folsom AR, Chambless LE, Wang CH, McGovern PG, Howard G, et al. Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke. 1999;30:736–43.

    Article  CAS  PubMed  Google Scholar 

  39. Zhang Y, Galloway JM, Welty TK, Wiebers DO, Whisnant JP, Devereux RB, et al. Incidence and risk factors for stroke in American Indians: the Strong Heart Study. Circulation. 2008;118:1577–84.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  PubMed  Google Scholar 

  41. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, 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(5):507–20. This article is the most recently published HTN guideline from the Eight Joint National Committee.

    Article  CAS  PubMed  Google Scholar 

  42. Krakoff LR, Gillespie RL, Ferdinand KC, Fergus IV, Akinboboye O, Williams KA, et al. 2014 hypertension recommendations from the eighth joint national committee panel members raise concerns for elderly black and female populations. J Am Coll Cardiol. 2014;64(4):394–402. This article is a state of the art review discussing the most recently published HTN guideline and viewpoints of two major writing groups in discordance with the new guidelines.

    Article  PubMed  Google Scholar 

  43. Flack JM, Sica DA, Bakris G, Brown AL, Ferdinand KC, Grimm Jr RH, et al. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010;56(5):780–800.

    Article  CAS  PubMed  Google Scholar 

  44. Ritchey MD, Wall HK, Gillespie C, George MG, Jamal A. Division for Heart Disease and Stroke Prevention, CDC. Million hearts: prevalence of leading cardiovascular disease risk factors—United States, 2005–2012. MMWR Morb Mortal Wkly Rep. 2014;63(21):462–7.

    PubMed  Google Scholar 

  45. Centers for Disease Control and Prevention (CDC). Million hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors—United States, 2011. MMWR Morb Mortal Wkly Rep. 2011;60(36):1248–51.

    Google Scholar 

  46. Ferdinand KC, Patterson KP, Taylor C, Fergus IV, Nasser SA, Ferdinand DP. Community-based approaches to prevention and management of hypertension and cardiovascular disease. J Clin Hypertens (Greenwich). 2012;14(5):336–43.

    Article  Google Scholar 

  47. Victor RG, Ravenell JE, Freeman A, Leonard D, Bhat DG, Shafiq M, et al. Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial. Arch Intern Med. 2011;171(4):342–50.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Yancy CW, Wang TY, Ventura HO, Piña IL, Vijayaraghavan K, Ferdinand KC, et al. The coalition to reduce racial and ethnic disparities in cardiovascular disease outcomes (credo): why credo matters to cardiologists. J Am Coll Cardiol. 2011;57(3):245–52.

    Article  PubMed  Google Scholar 

  49. Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large-scale hypertension program. JAMA. 2013;310(7):699–705.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Pelbreton Balfour, Jr. has no relevant disclosures. Keith Ferdinand has been a consultant for Astra Zeneca, Sanofi, Amgen, Novartis, Forest, Boehinger and Ingleheim. Carlos J. Rodriguez has received grants from the NIH/NHLBI. Rodriguez received consulting payments from Amgen, Alnylam, and the American Heart Association.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Pelbreton C. Balfour Jr. & Carlos J. Rodriguez

  2. Department of Medicine, Section of Cardiovascular Medicine, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Carlos J. Rodriguez

  3. Heart and Vascular Institute, Tulane University School of Medicine, 1430 Tulane Ave. #8548, New Orleans, LA, 70112, USA

    Keith C. Ferdinand

Authors
  1. Pelbreton C. Balfour Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos J. Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keith C. Ferdinand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keith C. Ferdinand.

Additional information

This article is part of the Topical Collection on Race + Ethnicity Disparities

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Balfour, P.C., Rodriguez, C.J. & Ferdinand, K.C. The Role of Hypertension in Race-Ethnic Disparities in Cardiovascular Disease. Curr Cardiovasc Risk Rep 9, 18 (2015). https://doi.org/10.1007/s12170-015-0446-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12170-015-0446-5

Keywords

Search

Navigation