Epidemiology of hypertension and hypertensive target-organ damage in the United States.

Hypertension and hypertension-related cardiovascular renal sequelae remain major clinical and public health problems in the United States, particularly among African Americans. Compared with whites, African Americans have higher incidence and prevalence rates for hypertension; these differentials are more pronounced in young adult women. Among the very old, race differentials in hypertension prevalence rates are less pronounced. The reasons for the epidemic hypertension rates in the United States are largely environmental: obesity, physical inactivity, high salt and alcohol intake, and psychosocial stress have all been identified as causes. Obesity and physical inactivity probably account for a significant proportion of the premature excess hypertension in African Americans relative to white women. Putative genetic differences between African Americans and whites are unlikely to account for the differential in hypertension rates. During the last 20 years tremendous strides have been made in the identification, treatment, and control of hypertension in the African-American community. Yet, there is further progress to be made. Preventing hypertension precursor conditions (ie, obesity, excess salt intake, psychosocial stressors), normalizing blood pressure levels (less than 140/90 mm Hg), reducing the prevalence of severe hypertension (greater than 160/90 mm Hg), and linking psychosocial correlates of blood pressure to cardiovascular-renal physiology (ie, salt sensitivity) remain as major challenges for those involved in hypertension management and research in African-American communities.