Hypertension and cardiac disease in minorities.

Despite recent advances in both prevention and treatment, cardiovascular disease remains the leading cause of mortality in the United States. One of the major modifiable risk factors for cardiovascular disease, hypertension, is a leading cause of stroke, kidney disease, and diseases of the heart and coronary circulation. Essential hypertension is the most common cause of systemic blood pressure elevation and it responds readily to both pharmacologic and non-pharmacologic treatment. More patients visit physicians and receive prescriptions for the treatment of hypertension than for any other medical disorder. Nevertheless, more than a million Americans die each year from the direct or indirect effects of hypertension. Over the last two decades, significant progress has been made in reducing mortality from cardiovascular disease. Through public health programs like the National High Blood Pressure Education Program, increasing numbers of hypertensive patients have been detected, treated and controlled. As a result, the number of deaths from stroke, kidney disease, and coronary artery disease has declined significantly. For both blacks and Hispanics, however, the decreases in cardiovascular mortality have been less striking. Many factors could account for this disparity, among them the availability of health care facilities in minority neighborhoods, and the health-care-seeking behavior of the patients themselves. Understanding epidemiologic and pathophysiologic data regarding differences between blacks, Hispanics, and non-Hispanic whites will help reduce hypertension-related morbidity and mortality.