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Figure 1. Heart attacks and strokes in Europeans, South Asians and African-Caribbeans in the Birmingham Factory Screening Project. There were insufficient numbers of South Asian women to allow statistical analysis. The ethnic differences noted here were not significant after correcting for age, BMI, cigarette smoking and blood pressure. CHD: Coronary heart disease; CVA: Cerebrovascular accident. Reproduced with permission from [31].
(Figure omitted. See article PDF.)
Figure 2. Plasma renin activity in African-American and non-African-American hypertensive patients in the Veterans Administration. Reproduced with permission from [39].
(Figure omitted. See article PDF.)
Figure 3. Meta-analysis of the reduction of systolic blood pressure in clinical trials of the commonly used antihypertensive drugs in African-Americans and non-African-Americans. ACE: Angiotensin-converting enzyme; SBP: Systolic blood pressure Reproduced with permission from [47].
(Figure omitted. See article PDF.)
Figure 4. The British Hypertension Society algorithm for the optimum choice of first-, second- and third-line antihypertensive drugs for uncomplicated hypertension. ACE: Angiotensin-converting enzyme; ARB: Angiotensin receptor blocker. Reproduced with permission from [49].
(Figure omitted. See article PDF.)
A great deal of research has been carried out into the epidemiology of hypertension in ethnic groups as well as the impact of ethnicity on clinical practice. Much of this literature comes from the USA and concentrates on hypertension in African-Americans. While it is probable that most of the ethnic differences in hypertension and cardiovascular disease are related to nurture rather than nature (i.e., diet and lifestyle rather than true ethnicity), there remain some unexplained ethnic differences that might be genuinely race related. In particular, it does appear that hypertension is different in patients of African origin compared with patients of other ethnic groups. It must be stressed, however, that these trends become less and less apparent after adjusting for differences in socio-economic statuses and environmental and lifestyle factors.
Epidemiology
African-origin populations
In global terms, the epidemiology of hypertension and of its cardiovascular complications are related to location, or probably more importantly, the degree of Westernization. In 'primitive' or unaculturated tribal societies in rural Africa, Asia and South America, hypertension and its complications are rare [1-4]. By contrast, in urban societies in all parts of the world, hypertension is common. This epidemiological transition is seen in all ethnic groups and is clearly related to the changes...