Hypertension in black South Africans

Hypertension is a major disease in the black populations of sub-Saharan Africa and the USA. The prevalence of hypertension varies from 1–30% in the adult population. Differences in blood pressure (BP) between black and white patients have been documented. In this review genetic, endocrine and environmental characteristics, renal physiology and cardiac function are reviewed. Racial differences in renal physiology and socio-economic status seem to account for BP differences. Black hypertensive patients in sub-Saharan Africa are prone to cerebral haemorrhage, malignant hypertension leading to uraemia and congestive heart failure, whereas coronary artery disease is relatively uncommon. Responses to antihypertensive drugs like the beta-blockers and the angiotensin-converting enzyme (ACE) inhibitors are poor unless these agents are combined with a thiazide diuretic. Black hypertensive patients respond best to diuretics, vasodilators or calcium channel blockers. A profiled approach to the treatment of hypertension in black patients is suggested.