The ESC Textbook of Cardiovascular Medicine (3 edn)
54.4 Ethnicity and hypertension
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Published:July 2018
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This version:April 2020
Abstract
Worldwide, large differences exist in the prevalence of hypertension and hypertension-mediated complications, both along geographic boundaries and between different ethnic groups. Urbanization and dietary changes have led to a genuine increase in hypertension prevalence in many low- and middle-income countries, whereas migration has been associated with disparities in hypertension prevalence, awareness, and control in different, multi-ethnic populations in Europe and the United States. Depending on the geographic area and definition of ethnicity results can be quite heterogeneous and are susceptible to generalization, but data in both Europe and the United States consistently show higher prevalence rates of hypertension and hypertension-mediated complications in populations of West African descent. These ethnic differences in hypertension susceptibility may in part be attributable to quantitative differences in other risk factors such as obesity and dietary salt intake, but may also relate to differences in physiological traits, in particular salt sensitivity and vascular contractility. While there is little evidence for a different reaction to blood pressure-lowering therapy in other ethnic groups, thiazide diuretics and calcium channel blocking agents are generally more effective in sub-Saharan African descent populations compared with renin–angiotensin system blockers and beta-blocking agents. The 2018 European Society of Hypertension/European Society of Cardiology Guidelines recommend to start withsingle-pill combinationtherapy in most hypertensive patients and to start with thiazide or thiazide-like diuretics and calciumchannel blockers in sub-Saharan African descent populationseithercombined with each other or with a renin–angiotensin system blocker as they make the latter more effective. The observeddisparities in hypertension prevalence and treatment responsesmay also help to increase our understanding of the complex pathophysiology of hypertension and improve strategies aimed at the selection and control of hypertension in the population at large.
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