Issues in the natural history and treatment of coronary heart disease in black populations: medical management.

Data from multiple sources indicate that the death rate for blacks is higher than for the general population-in part because of higher mortality from cardiovascular causes. The Cardiovascular Mortality Survey, carried out in Los Angeles, indicates that the combined effects of increased mortality from high blood pressure and related causes (e.g. stroke, cerebrovascular disease), together with an ischemic heart disease mortality rate that is only a little below the mean, accounts for the overall excess mortality rates in blacks. In addition, black patients have been shown to have higher risk profiles compared with the study mean in a large study of beta-blocker therapy, and a definite treatment effect was demonstrated. Further prospective studies of natural history and response to therapy are indicated for appropriately selected patient groups.