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Racial disparity in blood pressure risk revealed

Black patients are at greater risk of stroke, compared with white patients in the same systolic blood pressure bracket, say US researchers.

Their study found black patients had a mean 24% increase in the risk of stroke with a 10 mmHg increase in their systolic blood pressure, compared with an 8% increase in white patients.

In subjects aged 45 to 64 years with pre-hypertension – a systolic blood pressure of 120-139 mm Hg – black patients had a 38% greater risk of stroke compared with white patients.

This risk doubled in patients with stage 1 hypertension, with black patients having a more than two-fold greater risk of stroke compared with white patients.

NICE guidelines currently recommend different first-line hypertensive treatments in black people of African or Caribbean family origin - calcium channel blockers.

The authors concluded: ‘Blacks have more hypertension and are less likely to have it controlled, and when it is not controlled they are at greater risk for incident stroke (relative to whites with the same BP levels).

 ‘Our findings raise the potential that appropriate BP control, particularly for those aged 45 to 64 years, may play a major role in reducing the long-standing racial disparity in stroke risk in the United States.’

Dr Matthew Fay, a GPSI in cardiology in Bradford, said that the study showed there should be ‘aggressive follow up’ and rapid access to 24 hour ambulatory blood pressure monitoring in black patients.

He said: ‘Initial intervention with calcium channel blockers rather than ACE inhibitors is important, but this may be supplemented with spironolactone which can be very effective in people of African descent as the blood pressure can be driven much more from aldosterone.’

Arch Intern Med 2012, available online 10 December


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