Summary
Hypertension, once considered rare in Africa, occurs frequently in most Black populations outside of the continent as well as within more urban areas of Africa. The frequency of hypertension in Black citizens of the US is among the highest in the world. Pathophysiological mechanisms suggest the frequency of salt-sensitive blood pressure is more common in Black patients. More Black than White patients initially present with volume expansion. However, in Black patients there appears to be no significant relationship between plasma renin activity, plasma volume and blood pressure. The syndrome of insulin resistance has also been reported in African Americans. Future studies should address this issue, both because it relates to identifying individuals at risk for development of high blood pressure and because it has implications for initial selection of antihypertensive therapy.
Hypertensive kidney disease is prevalent in Black people. Lowering the blood pressure with diuretic-based therapies has not been shown to delay or prevent the loss of kidney function in patients with this condition, suggesting that this treatment approach may not be optimal.
Lifestyle modifications remain the initial therapeutic regimen. Because diuretics and β-blockers have been shown to reduce cardiovascular morbidity and mortality in controlled clinical trials, they are preferred therapies. The Hypertension Detection and Follow-up Program showed significant reductions in morbidity and mortality in Black patients using primarily diuretic-based therapies. However, controversy persists regarding use of diuretics since some investigators believe that greater reductions in overall cardiovascular risk may be achieved in Black patients using other agents. These agents may eventually be able to exert a beneficial cardiovascular effect in addition to and independent of their blood pressure-lowering effect. Long term data documenting reduced morbidity and mortality rates with other agents are needed for all populations, particularly in Black hypertensive patients.
Similar content being viewed by others
References
Akinkugbe OO. World epidemiology of hypertension in blacks. In Hall et al. (Eds) Hypertension in blacks: epidemiology, pathophysiology and treatment, pp. 3–16, Year Book Medical Publishers, Inc., Chicago, 1985
Anderson EA, Hoffman RP, Balon TW, Sinkey CA, Mark AL. Hyperinsulinemia produces both sympathetic neural activation and vasodilation in normal humans. Journal of Clinical Investigation 87: 2246–2252, 1991
Austin MA. Plasma triglyceride as a risk factor for coronary heart disease: the epidemiologic evidence and beyond. American Journal of Epidemiology 129: 249–259, 1989
Bar RS, Siddle K, Dolash S, Boes M, Dake B. Actions of insulin and insulinlike growth factors I and II in cultured microvessel endothelial cells from bovine adipose tissue. Metabolism 37: 714–720, 1988
Baron AD, Brechtel-Hook G, Johnson A, Hardin D. Skeletal muscle blood flow: a possible link between insulin resistance and blood pressure. Hypertension 21: 129–135, 1993
Baum M. Insulin stimulates volume absorption in the rabbit proximal convoluted tubule. Journal of Clinical Investigation 79: 1104–1109, 1987
Bengtsson C, Blohme G, Lapidus L, Lindquist O, Lundgren H, et al. Do antihypertensive drugs precipitate diabetes?. British Medical Journal 289: 1495–1497, 1984
Berglund G, Larsson B, Andersson O, et al. Body composition and glucose metabolism in hypertensive middle-aged males. Acta Medica Scandinavica 200: 163–169, 1976
Berne C, Fagius J, Pollare T, Hjemdahl P. The sympathetic response to euglycaemic hyperinsulinaemia. Diabetologia 35: 873–879, 1992
Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction: I. mortality results. Journal of the American Medical Association 247 12: 1707–1714, 1982
Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction: II. morbidity results. Journal of the American Medical Association 250(20): 2814–2819, 1982
Burke GL, Webber LS, Srinivasan SR, Radhakrishnamurthy B, Freedman DS. Fasting plasma glucose and insulin levels and their relationship to cardiovascular risk factors in children: the Bogalusa Heart Study. Metabolism 35: 441–446, 1986
Carvalho JJM, Baruzzi RG, Howard PF, Poulter N, Alpers MP, et al. Blood pressure in four remote populations in the INTERSALT study. Hypertension 14: 238–246, 1989
Cederholm J, Wibell L. Glucose intolerance in middle-aged subjects: a cause of hypertension?. Acta Medica Scandinavica 217: 363–371, 1985
Channick BJ, Adlin EV, Marks AD. Suppressed plasma renin activity in hypertension. Archives of Internal Medicine 123: 131–140, 1969
Chen KK, Poth EJ. Racial differences as illustrated by the mydriatic actions of cocaine, euphthalamine and ephedrine. Journal of Pharmacology and Experimental Therapeutics 36: 429–445, 1929
Chrysant SG, Danisa K, Kern DC, Dillard BL, Smith WJ, et al. Racial differences in pressure, volume and renin interrelationships in essential hypertension. Hypertension 1: 136–141, 1979
Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, et al. Epidemiology: blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet 335: 827–838, 1990
Connell JMC, McLellan AR. Hypertension, insulin, and atherogen-esis. Journal of Cardiovascular Pharmacology 18(Suppl. 2): S45–S50, 1991
Connett JE, Stamler J. Responses of black and white males to the special intervention program of the Multiple Risk Factor Intervention Trial. American Heart Journal 108: 839–848, 1984
Cooper R. A note on the biologic concept of race and its application in epidemiologic research. American Heart Journal 103: 715–723, 1984
Cooper R, David R. The biological concept of race and its application to public health and epidemiology. Health Politics, Policy, Law 11: 97–116, 1986
Crews DE, Bindon JR. Ethnicity as a taxonomie tool in biomedical and biosocial research. Ethnicity and Disease 1: 42–49, 1991
Croog SH, Kong BW, Levine S, Weir MR, Baume RM, et al. Hypertensive black men and women: quality of life and effects of antihypertensive medications. Archives of Internal Medicine 150: 1733–1741, 1990
Cubeddu LX, Aranda J, Singh B, Klein M, Branchfeld J, et al. A comparison of verapamil and propranolol for the initial treatment of hypertension: racial differences in response. Journal of the American Medical Association 256: 2214–2221, 1986
Curry CL, Oliver J, Mumtaz FB. Coronary artery disease in blacks: risk factors. American Heart Journal 108: 653–657, 1984
DeFronzo RA. Insulin and renal sodium handling: clinical implications. International Journal of Obesity 5(Suppl. 1): 93–104, 1981
DeFronzo RA, Cooke CR, Andres R, Faloona GR, Davis PJ. The effect of insulin on renal handling of sodium, potassium, calcium and phosphate in man. Journal of Clinical Investigation 55: 845–855, 1975
Denker PS, Pollock VE. Fasting serum insulin levels in essential hypertension: a meta-analysis. Archives of Internal Medicine 152: 1649–1651, 1992
Ducimetiere P, Eschwege E, Papozl L, et al. Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease in a middle-aged population. Diabetologia 19: 205–210, 1980
Elliot P, Dyer A, Stamler R. The INTERSALT study: results for 24 hour sodium and potassium, by age and sex. Journal of Human Hypertension 3: 323–330, 1989
Falkner B, Hulman S, Kushner H. Insulin-stimulated glucose utilization and borderline hypertension in young adult blacks. Hypertension 22: 18–25, 1993
Falkner B, Hulman S, Tannenbaum J, Kushner H. Insulin resistance and blood pressure in young black men. Hypertension 16: 706–711, 1990
Falkner B, Kushner H. Effect of chronic sodium loading on cardiovascular response in young blacks and whites. Hypertension 15: 36–43, 1990
Ferrannini E, Buzzigoli G, Bonadonna R, Giorico MA, Oleggini M, et al. Insulin resistance in essential hypertension. New England Journal of Medicine 317: 350–357, 1987
Ferrannini E, DeFronzo RA. The association of hypertension, diabetes, and obesity: a review. Journal of Nephrology 1: 3–15, 1989
Ferrannini E, Natali A. Essential hypertension, metabolic disorders, and insulin resistance. American Heart Journal 121: 1274–1282, 1991
Flapan AD, Stewart SE, McDougal F, Padfield PL. Is self home-monitoring of blood pressure as good as 24 hour ambulatory monitoring. Journal of Hypertension 5(Suppl. 5): S491–S493, 1987
Freis ED, Materson BJ, Blamenbaum V. Comparison of propranolol or hydrochlorothiazide alone for treatment of hypertension: III. evaluation of the renin-angiotensin system. American Journal of Medicine 74: 1029–1041, 1983
Freis ED, Reda DJ, Materson BJ. Volume (weight) loss and blood pressure response following thiazide diuretics. Hypertension 12: 244–250, 1988
Frishman WH, Zawada Jr ET, Smith LK, Sowers J, Swartz SL, et al. Comparison of hydrochlorothiazide and sustained-release diltiazem for mild-to-moderate systemic hypertension. American Journal of Cardiology 59 6: 615–623, 1987
Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Coronary-heart-disease risk and impaired glucose tolerance: the Whitehall study. Lancet 1: 1373–1376, 1980
Fumo MT, Teeger S, Lang RM, Bednarz J, Sareli P, et al. Diurnal blood pressure variation and cardiac mass in American blacks and whites and South African blacks. American Journal of Hypertension 5: 111–116, 1992
Giaconi S, Levanti C, Fommei E, Innocenti F, Seghieri G, et al. Microalbuminuria and casual and ambulatory blood pressure monitoring in normotensives and in patients with borderline and mild essential hypertension. American Journal of Hypertension 2: 259–261, 1989
Gleiberman L. Blood pressure and dietary salt in human populations. Ecology, Food and Nutrition 2: 143–156, 1973
Greene AS, Tonellato PJ, Lui J, Lombard JH, Cowley Jr AW. Microvascular rarefaction and tissue vascular resistance in hypertension. American Journal of Physiology 256: H126–H131, 1989
Gretlet DD, Fumo MT, Nelson KS, Murphy MB. Ethnic differences in circadian hemodynamic profile. American Journal of Hypertension 7: 7–14, 1994
Groden DL. Vasodilator therapy for congestive heart failure: lessons from mortality trials. Archives of Internal Medicine 153: 445–454, 1993
Haffner SM, Mitchell BD, Stern MP, Hazuda HP, Patterson JK. Decreased prevalence of hypertension in Mexican Americans. Hypertension 16: 225–232, 1990
Harris MI. Impaired glucose tolerance in the U.S. population. Diabetes Care 12: 464–474, 1989
Harshfield GA, Alpert B, Willey E, Somes G, Murphy J, et al. Race and gender influence ambulatory blood pressure patterns of adolescents. Hypertension 14: 598–603, 1989
Harshfield GA, Hwang C, Grim C. The circadian variation of blood pressure in blacks: influence of age, gender and activity. Journal of Human Hypertension 4: 43–47, 1990
Hypertension Detection and Follow-up Program Cooperative Group. Persistence of reduction in blood pressure and mortality of participants in the Hypertension Detection and Follow-up Program. Journal of the American Medical Association 259: 2113–2122, 1988
Herbert PR, Moser M, Mayer J, Glynn RJ, Hennekens CH. Recent evidence on drug therapy of mild to moderate hypertension and decreased risk of coronary heart disease. Archives of Internal Medicine 153: 578–581, 1993
Holland OB, Gomez-Sanchez CE, Kuhnert L. Antihypertensive comparison of furosemide with hydrochlorothiazide for black patients. Archives of Internal Medicine 139: 1015–1021, 1979
Hollenberg NK. Management of hypertension: considerations involving cardiovascular risk reduction. Journal of Cardiovascular Pharmacology 15: 573–578, 1990
INTERSALT Cooperative Research Group. INTERSALT, an international study of electrolyte excretion and blood pressure: results for 24 hour urinary sodium and potassium. British Medical Journal 294: 319–328, 1988
Jackson FLC. An evolutionary perspective on salt, hypertension, and human genetic variability. Hypertension 17 [Suppl. I]: 1129–1132, 1991
Jackson FLC. Race and ethnicity as biological constructs. Ethnicity and Disease 2: 120–125, 1992
James DE, Jenkins AB, Kraegen EW. Heterogeneity of insulin action in individual muscles in vivo: euglycemic clamp studies in rats. American Journal of Physiology 248: E567–E574, 1985
James GD, Pickering TG, Yee LS, Harshfield GA, Riva S, et al. The reproducibility of average ambulatory, home, and clinic pressures. Hypertension 11: 545–549, 1988
Joint National Committee 1984. Hypertension prevalence and the status of awareness, treatment, and control in the United States: final report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee. Hypertension 7: 457–468, 1985
Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Archives of Internal Medicine 153: 154–183, 1993
Johnson AG, Simons LA, Simons J, Friedlander Y, McCallum J. Non-steroidal anti-inflammatory drugs and hypertension in the elderly: a community-based cross-sectional study. British Journal of Clinical Pharmacology 35: 455–459, 1993
Johnson JL, Heineman EF, Heiss G, Harnes CG, Tyroler HA. Cardiovascular disease risk factors and mortality among black women and white women aged 40-64 years in Evans County, Georgia. American Journal of Epidemiology 123: 209–220, 1986
Joseph JC, Schuna AA. Management of hypertension in the diabetic patient. Clinical Pharmacy 9: 864–873, 1990
Joubert PH, Brandt HD. Apparent racial differences in response to angiotensin I infusion. European Journal of Clinical Pharmacology 39: 183–185, 1990
Juhlin-Dannfelt A, Frisk-Holmberg M, Karlsson J, Tesch P. Central and peripheral circulation in relation to muscle-fibre composition in normo- and hypertensive man. Clinical Science 56: 335–340, 1979
Kannel WB, Brand N, Skinner Jr JJ, Dawber TR, McNamar PM. The relation of adiposity to blood pressure and development of hypertension: the Framingham Study. Annals of Internal Medicine 67: 48–59, 1967
Kannel WB, Gordon T, Castelli WP, Margolis JR. Electrocardiographic left ventricular hypertrophy and risk of coronary heart disease. Annals of Internal Medicine 72: 813–822, 1970
Kannel WB. Prevalence and natural history of electrocardiographic left ventricular hypertrophy. American Journal of Medicine 75: 4–11, 1983
Kaplan NM. The deadly quartet: upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Archives of Internal Medicine 149: 1514–1520, 1989
Kaplan NM. Antihypertensive therapy to maximally reduce coronary risk. American Heart Journal 125, 1487–1493, 1993
Kaplan NM, Weidmann P. Introduction: is hypertension a metabolic disease?. American Heart Journal 125: 1485–1487, 1993
Kenny RA, Brennan M, O’Malley K, O’Brien E. Blood pressure measurement in borderline hypertension. Journal of Hypertension 5(Suppl. 5): S483–S485, 1987
Kiple KF, Higgins BT. Mortality caused by dehydration during the Middle Passage. In Inikori & Engerman (Eds) The Atlantic slave trade: effects on economies, societies, and peoples in Africa, the Americas, and Europe, pp. 321–337, Duke University Press, Durham and London, 1992
Kirn TF, Windom RE, Roper WL, Wyngaarden JB. Research seeks to reduce toll of hypertension, other cardiovascular diseases in black population. Journal of the American Medical Association 261: 195–200, 1989
Laakso M, Edelman S, Brechtel FG, Baron A. Decreased insulin mediated glucose uptake (IMGU) in human obesity is largely due to reduced plasma flow (PF) to insulin sensitive tissue. Abstract. Diabetes 38(Suppl.2): 269, 1989
Lackland DT, Orchard TJ, Keil JE, Saunders Jr DE, Wheeler FC, et al. Are race differences in the prevalence of hypertension explained by body mass and fat distribution?: a survey in a biracial population. International Journal of Epidemiology 21: 236–245, 1992
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Left ventricular mass and incidence of coronary heart disease in an elderly cohort: the Framingham Heart Study. Annals of Internal Medicine 110: 101–107, 1989
Lillioja S, Young AA, Cutter CL, et al. Skeletal muscle capillary density and fibre type are possible determinants of in vivo insulin resistance in man. Journal of Clinical Investigation 80: 415–424, 1987
Luft FC, Grim CE, Feinberg N, Weinberger MH. Effects of volume expansion and contraction in normotensive whites, blacks and subjects of different ages. Circulation 59: 643–650, 1979b
Luft FC, Rankin LI, Bloch R, Yeymen AE, Willis LR, et al. Cardiovascular and humoral responses to extremes of sodium intake in normal white and black men. Circulation 60: 697–706, 1979a
MacMahon S, Peto R, Culter J, Collins R, Sorlie P, et al. Epidemiology: blood pressure, stroke, and coronary heart disease: part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression of dilution bias. Lancet 335: 765–774, 1990
Manning P. The slave trade: the formal demography of a global system. In Inikori & Engerman (Eds) The Atlantic slave trade: effects on economies, societies, and peoples in Africa, the Americas, and Europe, pp. 117–141, Duke University Press, Durham and London, 1992
Materson BJ, Cushman WC, Goldstein G, Reda DJ, Freis ED, et al. Treatment of hypertension in the elderly: I. blood pressure and clinical changes: results of a Department of Veterans Affairs Cooperative Study. Hypertension 15: 348–360, 1990
Materson BJ, Reda DJ, Cushman WC, Massie BM, Freis ED, et al. Single-drug therapy for hypertension in men: a comparison of six antihypertensive agents with placebo. New England Journal of Medicine 328: 914–921, 1993
Mathias CJ, Da Costa DF, Fosbraey P, Christensen NJ, Bannister R. Hypotensive and sedative effects of insulin in autonomic failure. British Medical Journal 295: 161–163, 1987
MIAMI Trial Research Group. Metoprolol in acute myocardial infarction (MIAMI): a randomised placebo-controlled international trial. European Heart Journal 6: 199–226, 1985
Mitchell BD, Stern MP, Haffner SM, Hazuda HP, Patterson JK. Risk factors for cardiovascular mortality in Mexican Americans and non-Hispanic whites: the San Antonio Heart Study. American Journal of Epidemiology 131: 423–433, 1990
Moser M, Lunn J. Comparative effects of pindolol and hydrochlorothiazide in black hypertensive patients. Angiology 32: 561–566, 1981
Mufunda J, Sparks Jr HV. Salt sensitivity and hypertension in African blacks. In Fray & Douglas (Eds) Pathophysiology of hypertension in blacks, pp. 143–165, Oxford University Press, New York, 1993
Mulvany MJ. Pathophysiology of vascular smooth muscle in hypertension. Journal of Hypertension 2(Suppl. III): 413–420, 1984
Natali A, Santoro D, Palombo C, Cerri M, Ghione S, et al. Impaired insulin action on skeletal muscle metabolism in essential hypertension. Hypertension 17: 170–178, 1991
National Center for Health Statistics. Health, United States, 1986. DHHS 87-1232, US Government Printing Office, Washington, 1986
National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Archives of Internal Medicine 153: 186–208, 1993
National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on hypertension in the elderly. Hypertension 23: 275–285, 1994a
National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension 23: 145–158, 1994b
Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. New England Journal of Medicine 304 14: 801–807, 1981
O’Brien E, O’Malley K. Clinical blood pressure measurement. In Robertson (Ed.) Handbook of hypertension, Vol. 15, pp. 14–50, Elsevier, New York, 1992
Otten MW, Teutsch SM, Williamson DF, Marks JS. The effect of known risk factors on the excess mortality of black adults in the United States. Journal of the American Medical Association 263: 834–850, 1990
Pfeffer MA, Braunwald E, Moyé LA, Basta L, et al. on behalf of the SAVE Investigators. Effect of Captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial. New England Journal of Medicine 327 10: 667–677, 1992
Pickering TG. Hypertension: definitions, natural histories, and consequences. In Laragh & Brenner (Eds) Hypertension: pathophysiology, diagnosis, and management, Vol. 1, pp. 3–16, Raven Press, New York, 1990a
Pickering TG. Afterword to Chapter 1. In Laragh & Brenner (Eds) Hypertension: pathophysiology, diagnosis, and management, Vol. 1, pp. 17–20, Raven Press, New York, 1990b
Plavinik FL, Rodrigues CIS, Zanella MT, Ribeiro AB. Hypokalemia, glucose intolerance, and hyperinsulinemia during diuretic therapy. Hypertension 19(Suppl. II): II–26–II–29, 1992
Pollare T, Lithell H, Berne CA comparison of hydrochlorothiazide and Captopril on glucose and lipid metabolism in patients with hypertension. New England Journal of Medicine 321: 868–873, 1989a
Pollare T, Lithell H, Morlin C, Prantare H, Hvarfner A, et al. Metabolic effects of diltiazem and atenolol: results from a randomized double-blind study with parallel groups. Journal of Hypertension 7: 551–559, 1989b
Pope JE, Anderson JJ, Felson DT. A meta-analysis of the effects of nonsteroidal anti-inflammatory drugs on blood pressure. Archives of Internal Medicine 153: 477–484, 1993
Pyorala K. Relationship of glucose tolerance and plasma insulin to the incidence of coronary heart disease: results from two population studies in Finland. Diabetes Care 2: 131–141, 1979
Reaven GM. Role of insulin resistance in human disease. Diabetes 37: 1595–1607, 1988
Reaven GM. Clinical ceview 43: treatment of hypertension. Focus on prevention of coronary heart disease. Journal of Clinical Endocrinology and metabolism 76: 537–540, 1993a
Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annual Review in Medicine 44: 121–131, 1993b
Reaven GM, Ho H. Renal vascular hypertension does not lead to hyperinsulinemia in Sprague-Dawley rats. American Journal of Hypertension 5: 314–317, 1992
Rimm IJ, Rimm AA. Association between socioeconomic status and obesity in 59,556 women. Preventive Medicine 3: 543–552, 1974
Rowe JW, Young JB, Minaker KL, Stevens AL, Pallotta J, et al. Effect of insulin and glucose infusions on sympathetic nervous system activity in normal man. Diabetes 30: 219–225, 1981
Rutledge DR, Wallace A, Steinberg JD, Cardozo LJ, Lavine SJ. Racial differences in drug response: isoproterenol effects on cardiac function before and after propranolol. Pharmaceutical Research 8: 754–757, 1991
Rutledge DR. Are there β-adrenergic receptor response differences between racial groups? Annals of Pharmacotherapy 25: 824–834, 1991
Saad MF, Lillioja S, Nyomba BL, Castillo C, Ferraro R, et al. Racial differences in the relation between blood pressure and insulin resistance. New England Journal of Medicine 324: 733–739, 1991
Saudek CD, Boulter PR, Knopp RH, Arky RA. Sodium retention accompanying insulin treatment of diabetes mellitus. Diabetes 23: 240–246, 1974
Saunders E. Hypertension in blacks. Medical Clinics of North America 71 5: 1013–1029, 1987
Saunders E, Weir MR, Kong W, Hollifield J, Gray J, et al. A comparison of the efficacy and safety of a β-blocker, a calcium channel blocker, and a converting enzyme inhibitor in hypertensive blacks. Archives of Internal Medicine 150: 1707–1713, 1990
Schalekamp MA, Lebel M, Beevers DG, Fraser R, Kolstgers G, et al. Body-fluid volume in low-renin hypertension. Lancet 2: 310–311, 1974
Seedat YK, Hackland DBT. The prevalence of hypertension in 4,993 rural Zulus. Transactions of the Royal Society of Tropical Medicine and Hygiene 78: 785–789, 1984
Shamiss A, Carroll J, Rosenthal T. Insulin resistance in secondary hypertension. American Journal of Hypertension 5: 26–28, 1992
Sharma AM, Ruland K, Spies KP, Distler A. Salt sensitivity in young normotensive subjects is associated with a hyperinsulinemic response to oral glucose. Journal of Hypertension 9: 329–335, 1991
Sharma AM, Schorr U, Distler A. Insulin resistance in young salt-sensitive normotensive subjects. Hypertension 21: 273–279, 1993
Singer P, Godicke W, Voigt S, Hajdu I, Weiss M. Postprandial hyperinsulinemia in patients with mild essential hypertension. Hypertension 7: 182–186, 1985
Sowers JR, Zemel MB. Clinical implications of hypertension in the diabetic patient. American Journal of Hypertension 3: 415–424, 1990
Sowers JR, Zemel PC, Zemel MB. Role of nutrition in black hypertension: calcium and other dietary factors. In Fray & Douglas (Eds) Pathophysiology of hypertension in blacks, pp. 166–180, Oxford University Press, New York, 1993
Spence JD. The arthritic patient with hypertension: selection of an NSAID. Scandinavian Journal of Rheumatology (Suppl.) 62: 36–40, 1986
Stout RW. Insulin as a mitogenic factor: role in the pathogenesis of cardiovascular disease. American Journal of Medicine 90(Suppl. 2A): 2A–62S–2A–65S, 1991
Strom BL, Carson JL, Morse ML, LeRoy AA. The computerized on-line Medicaid pharmaceutical analysis and surveillance system: a new resource for postmarketing drug surveillance. Clinical Pharmacology and Therapeutics 38: 359–364, 1985
Trowell HC. Hypertension, obesity, diabetes mellitus, and coronary heart disease. In Burkitt & Trowell (Eds) Western diseases: their emergence and prevention, pp. 3–32, Edward Arnold, London, 1981
US Renal Data System. USRDS 1991 Annual Report, National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, 1991
Veterans Administration Cooperative Study Group on Antihypertensive Agents. Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension. Journal of the American Medical Association 248: 1996–2003, 1982
Veterans Administration Cooperative Study Group on Antihypertensive Agents. Efficacy of nadolol alone and combined with bendroflumethiazide and hydralazine for systemic hypertension. American Journal of Cardiology 52: 1230–1237, 1983
Veterans Administration Cooperative Study Group on Antihypertensive Agents. Urinary and serum electrolytes in untreated black and white hypertensives. Journal of Chronic Diseases 40: 839–847, 1987
Verdecchia P, Schillaca G, Guerreri M, Galteschi C, Benemio G, et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 81: 521–536, 1990
Walker ARP. Studies bearing on coronary heart disease in South African populations. South African Medical Journal 47: 85–90, 1973
Walker ARP, Walker BE. Coronary disease in blacks in underdeveloped populations. American Heart Journal 109: 1410–1411, 1985
Walker WG, Neaton JD, Cutler JA, Neuwirth R, Cohen JD. Renal function change in hypertensive members of the multiple risk factor intervention trial: racial and treatment effects. Journal of the American Medical Association 268: 3085-3091
Wallin JD. Hypertension in black patients: epidemiologic and pathophysiologic considerations. Journal of Clinical Hypertension 1: 7–12, 1986
Watkins LO. Coronary heart disease and coronary disease risk factors in black populations in underdeveloped countries: the case for primordial prevention. American Heart Journal 108: 850–862, 1984
Weber MA, Laragh JH. Hypertension: steps forward and steps backward. Archives of Internal Medicine 153: 149–152, 1993
Weinberger MH, Miller JZ, Luft FC, Grim CE, Fienberg NS. Definitions and characteristics of sodium sensitivity and blood pressure resistance. Hypertension 8(Suppl. II): II–127–11–134, 1986
Welborn TA, Breckenridge A, Rubinstein AH, Dollery CT, Rüssel Fraser T. Serum insulin in essential hypertension and in peripheral vascular disease. Lancet 1: 1336–1337, 1966
Welborn TA, Wearne K. Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations. Diabetes Care 2: 154–160, 1979
Whelton PK, Klag MJ. Hypertension as a risk factor for renal disease: review of clinical and epidemiological evidence. Hypertension 13: 119–127, 1989
White WB, Dey HM, Schulman P. Assessment of the daily blood pressure load as a determinant of cardiac function in patients with mild-to-moderate hypertension. American Heart Journal 118: 782–795, 1989
Willich SN, Goldberg RJ, Madure M, Perriello L, Muller JE. Increased onset of sudden cardiac death in the first three hours after awakening. American Journal of Cardiology 70: 65–68, 1992
Wilson TW. History of salt supplies in West Africa and blood pressures today. Lancet 1: 784–786, 1986
Wilson TW, Grim CE. Biohistory of slavery and blood pressure differences in blacks today: a hypothesis. Hypertension 17(Suppl. I): I122–I128, 1991
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rutledge, D.R. Race and Hypertension. Drugs 47, 914–932 (1994). https://doi.org/10.2165/00003495-199447060-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199447060-00005