Racial and Ethnic Differences in Blood Pressure
2006; Lippincott Williams & Wilkins; Volume: 114; Issue: 25 Linguagem: Inglês
10.1161/circulationaha.106.668731
ISSN1524-4539
AutoresDaniel W. Jones, John E. Hall,
Tópico(s)Sodium Intake and Health
ResumoHomeCirculationVol. 114, No. 25Racial and Ethnic Differences in Blood Pressure Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBRacial and Ethnic Differences in Blood PressureBiology and Sociology Daniel W. Jones and John E. Hall Daniel W. JonesDaniel W. Jones From the Center for Excellence in Cardiovascular–Renal Research, Department of Medicine, Department of Physiology and Biophysics, University of Mississippi Medical Center. and John E. HallJohn E. Hall From the Center for Excellence in Cardiovascular–Renal Research, Department of Medicine, Department of Physiology and Biophysics, University of Mississippi Medical Center. Originally published19 Dec 2006https://doi.org/10.1161/CIRCULATIONAHA.106.668731Circulation. 2006;114:2757–2759In the last few years, much attention has been given to racial and ethnic differences in health measures. Not surprisingly, much of the work in this area is being done in the United States. Not only does our unique racial and ethnic diversity offer opportunities for study, but the social and political issues related to this diversity have driven a need to understand the disparities in health related to these differences.Article p 2780These racial and ethnic differences in health measures are seen clearly in cardiovascular disease risk factors and outcomes for Americans of African descent, or African Americans (AAs), compared with those of European descent, or European Americans (EAs). Compared with EAs, AAs have higher mortality rates for most cardiovascular diseases, including coronary heart disease and stroke. These differences are magnified at younger ages.1Prevalence rates for key risk factors differ for AAs, with higher rates for hypertension, obesity, and diabetes mellitus, and lower rates for dyslipidemia. Additionally, the cardiovascular consequences imposed by various risk factors differ by race. Compared with hypertensive EA men and women and AA men, AA women with hypertension have a substantially greater relative risk for heart disease. Conversely, AA women have a substantially lower relative risk for diabetes mellitus than EA women.2The disparities in cardiovascular outcome are large and significant, and the disparities in outcome have worsened in the last 2 decades.3 Appropriately, much attention is being given to understanding these differences.For a number of years, this important area of study was hampered by a lack of interest and a lack of funding. Now that a commitment is being made in this area, other challenges of understanding the causes of these differences are becoming clearer. The science is complex.3The challenges to understanding the science of racial differences and disparities in cardiovascular disease are substantial. Race and ethnicity are difficult to define and classify. The biology is driven by a complex set of gene/gene, environment/environment, and gene/environment interactions. Among the environmental influences are social issues that may induce stress and potentially influence multiple physiological functions. These are difficult to measure, and understanding the biological consequences is difficult. Other social issues such as access to care have less interaction with biology, but these issues drive some of the differences in outcome.Research in this area is hampered by the small knowledge base. Most of what is known has been gained through observational studies. Moving from the knowledge gained in observations to experimental design has not been easy. This area of study does not lend itself easily to biological exploration through animal models. And, just as clinical trials exploring gender differences are challenged by design issues, trials exploring racial differences are difficult to design.Most of what is known about racial differences in hypertension and cardiovascular disease comes from studies in adults. Understanding the root causes of vascular disease in adult patients is often complicated by the vascular changes brought on by the disease. This is especially true in studying hypertension because blood pressure patterns are often impacted by the vascular disease, which may occur as a consequence of the blood pressure abnormalities.This has been particularly problematic in studying hypertension and vascular disease in AAs. In young adults, cardiovascular disease rates are substantially higher in AAs than in EAs. The onset of vascular changes occurs earlier, and risk factors also are seen earlier, especially obesity, hypertension, and diabetes mellitus.The study by Wang et al4 in this issue of Circulation makes an important contribution to our understanding of racial differences in blood pressure. The authors report that the blunting of nocturnal blood pressure declines in AAs begins by age 10 years and that this blunted decline is exacerbated with age during the years of adolescence.In addition to racial differences in prevalence rates of hypertension, differences in the blood pressure pattern demonstrated through 24-hour ambulatory blood pressure monitoring have been reported.5 Compared with EAs, AAs have higher nocturnal blood pressure and a smaller difference between daytime pressures. That is, compared with EAs, AAs have less "dip" in blood pressure at night.6 This "nondipping" status is strongly associated with higher rates of vascular disease.7The finding that this lack of nighttime decline in blood pressure is seen in AAs at a very young age and accelerates during adolescent years is important. The authors appropriately suggest that this increased blood pressure burden may be an important cause of the excessive cardiovascular disease rates in AAs and may account for the frequent early onset of vascular disease.Understanding this potential explanation for excessive vascular disease in AAs is important, and the opportunity to explore the causes of blood pressure differences among young AAs could be highly important in understanding how better to prevent premature onset of disease. The authors note that the lack of nocturnal dipping is not seen in groups of African descent outside the United States.8 This leads the authors to conclude that this blunting of nocturnal decline seen in AAs is not purely genetic in origin but is likely the result of a gene/environment interaction. Depending on the Guyton model of long-term blood pressure control through pressure natriuresis, they suggest that some environmental factor causes sodium retention, leading to a need for a higher nocturnal pressure to excrete the sodium load.9The authors report some evaluation of potential causes through their analysis of environmental associations with the nondipping status. In their interpretation of the findings, the authors point to the possibility of social factors, including stress-induced sodium retention.Among the social factors considered, the study used a tool to measure John Henryism. This scale measures active coping responses to stress. It may be surprising to some that this stress-related association with blood pressure abnormalities was present at a very young age. Importantly, the authors note that the impact of stress on blood pressure as measured by this John Henryism scale was seen in both AAs and EAs.Understanding the relationship between stress, blood pressure, and vascular disease is complicated. The methodologies are complex and controversial. Most of the human data demonstrating a link are observational. Most experimental data that seem to support a cause-and-effect relationship are from animal models.10 In humans, it has been difficult to show long-term benefit on blood pressure with available therapies for management of stress. On the basis of the current evidence, major guidelines do not list stress as a risk factor for hypertension or cardiovascular disease, and the guidelines offer no specific recommendations for stress management as a tool for improving blood pressure.11The other major association with nondipping status noted was that of adiposity, or body mass. The authors report a strong association with blood pressure status and body mass index (BMI), as have many other studies.As explanations of the early blood pressure differences between AAs and EAs are explored, body weight and BMI deserve further exploration. Racial differences in BMI have been noted at an early age in other studies, and this difference is also seen in the study by Wang et al4. The mean BMI of 24.8 in AA females in the Wang et al study indicates that about half of this cohort, with an average age of 14.4 years, was overweight. Mean BMI for AAs was about 10% higher than for EAs at this early age in both males and females. This contrasts with almost identical scores for John Henryism across race.Both BMI and blood pressure are continuous variables. The arbitrary cutoff points are necessary for clinical decision making, but they are artificial. The relationship between BMI and blood pressure is roughly linear and extends well into the lean range.12 Understanding that this relationship does not depend on adiposity, overweight, or obese status suggests that body weight may be an important cause of the early differences seen in blood pressure profiles across race. Also, the location of excess fat seems to be an important factor in determining the impact of adiposity on cardiovascular risk, with excess visceral adiposity conveying much greater risk that subcutaneous adiposity. However, the importance of these differences in contributing to racial and ethnic disparities in hypertension and cardiovascular disease is still poorly understood and should be explored further.In the study by Wang et al,4 data on the intake and excretion of sodium and potassium were not available. Racial differences in intake and handling of sodium and potassium have been noted in other studies.13 This may be another area that might be helpful for understanding blood pressure differences at an early age.Although there are substantial challenges in the area of racial disparities in hypertension and cardiovascular disease, there is some very good news. We have strong evidence that the treatment options available for managing hypertension have similar benefit in lowering blood pressure and in reducing cardiovascular events in EAs and AAs.14 There are subtle differences in response across race, most notably in degree of blood pressure decreases in response to individual drug classes. But, with hypertension therapy, there are very similar and impressive benefits to reduction of both heart disease and stroke in AAs and EAs.Wang et al4 have made an important contribution to our understanding of an important and complex topic. As they note, further study of this area is warranted. Causes of early racial differences in blood pressure profile must be understood. Gene/environment interactions should be explored. Target environmental elements should include stress, body weight, and sodium and potassium intake and handling.It is important to move forward to expand our knowledge base through further research, but it is equally important to assure appropriate treatment across race. We must take advantage of the good hypertension-management tools available to us now. Applying our current knowledge in the management of hypertension to all, regardless of race, will save many lives and go a long way toward eliminating the existing racial disparities.The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.DisclosuresNone.FootnotesCorrespondence to Daniel W. Jones, MD, Office of the Vice Chancellor, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505. E-mail [email protected] References 1 Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T, Zheng ZJ, Flegal K, O'Donnell C, Kittner S, Lloyd-Jones D, Goff DC Jr, Hong Y, Adams R, Friday G, Furie K, Gorelick P, Kissela B, Marler J, Meigs J, Roger V, Sidney S, Sorlie P, Steinberger J, Wasserthiel-Smoller S, Wilson M, Wolf P, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006; 113: e85–e151.LinkGoogle Scholar2 Jones DW, Chambless LE, Folsom AR, Heiss G, Hutchinson RG, Sharrett AR, Szklo M, Taylor HA. Risk factors for coronary heart disease in African Americans: the atherosclerosis risk in communities study, 1987–1997. Arch Intern Med. 2002; 162: 2565–2571.CrossrefMedlineGoogle Scholar3 Jones DW, Sempos CT, Thom TJ, Harrington AM, Taylor HA Jr, Fletcher BW, Mehrotra BD, Wyatt SB, Davis CE. Rising levels of cardiovascular mortality in Mississippi, 1979–1995. Am J Med Sci. 2000; 319: 131–137.MedlineGoogle Scholar4 Wang X, Poole JC, Treiber FA, Harshfield GA, Hanevold CD, Snieder H. Ethnic and gender differences in ambulatory blood pressure trajectories: results from a 15-year longitudinal study in youth and young adults. Circulation. 2006: 114: 2780–2787.LinkGoogle Scholar5 Profant J, Dimsdale JE. Race and diurnal blood pressure patterns. A review and meta-analysis. Hypertension. 1999; 33: 1099–1104.CrossrefMedlineGoogle Scholar6 Harshfield GA, Hwang C, Grim CE. Circadian variation of blood pressure in blacks: influence of age, gender and activity. J Hum Hypertens. 1990; 4: 43–47.MedlineGoogle Scholar7 Kikuya M, Ohkubo T, Asayama K, Metoki H, Obara T, Saito S, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y. Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study. Hypertension. 2005; 45: 240–245.LinkGoogle Scholar8 Fumo MT, Teeger S, Lang RM, Bednarz J, Sareli P, Murphy MB. Diurnal blood pressure variation and cardiac mass in American blacks and whites and South African blacks. Am J Hypertens. 1992; 5: 111–116.CrossrefMedlineGoogle Scholar9 Harshfield GA, Treiber FA, Davis H, Kapuku GK. Impaired stress-induced pressure natriuresis is related to left ventricular structure in blacks. Hypertension. 2002; 39: 844–847.LinkGoogle Scholar10 Lucini D, Di Dede G, Parati G, Pagani M. Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension. 2005; 46: 1201–1206.LinkGoogle Scholar11 Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure; National Heart, Lung and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42: 1206–1252.LinkGoogle Scholar12 Jones DW, Kim JS, Andrew ME, Kim SJ, Hong YP. Body mass index and blood pressure in Korean men and women: the Korean National Blood Pressure Survey. J Hypertens. 1994; 12: 1433–1437.CrossrefMedlineGoogle Scholar13 Andrew ME, Jones DW, Wofford MR, Wyatt SB, Schreiner PJ, Brown CA, Young DB, Taylor HA. Ethnicity and unprovoked hypokalemia in the Atherosclerosis Risk in Communities Study. Am J Hypertens. 2002; 15: 594–599.CrossrefMedlineGoogle Scholar14 The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288: 2981–2997.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. 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Abrahamowicz A, Ebinger J, Whelton S, Commodore-Mensah Y and Yang E (2023) Racial and Ethnic Disparities in Hypertension: Barriers and Opportunities to Improve Blood Pressure Control, Current Cardiology Reports, 10.1007/s11886-022-01826-x, 25:1, (17-27), Online publication date: 1-Jan-2023. Wang X, Carcel C, Woodward M and Schutte A (2022) Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure, Stroke, 53:4, (1114-1133), Online publication date: 1-Apr-2022.King J, Pinheiro L, Bryan Ringel J, Bress A, Shimbo D, Muntner P, Reynolds K, Cushman M, Howard G, Manly J and Safford M (2021) Multiple Social Vulnerabilities to Health Disparities and Hypertension and Death in the REGARDS Study, Hypertension, 79:1, (196-206), Online publication date: 1-Jan-2022. Gordon N and Hsueh L (2021) Racial/ethnic, gender, and age group differences in cardiometabolic risks among adults in a Northern California health plan: a cross-sectional study, BMC Public Health, 10.1186/s12889-021-11011-4, 21:1, Online publication date: 1-Dec-2021. Zhang Y, Feng Y, Chen S, Liang S, Wang S, Xu K, Ning D, Yuan X, Zhu H, Pan H and Shan G (2021) Relationship between the duration of smoking and blood pressure in Han and ethnic minority populations: a cross-sectional study in China, BMC Public Health, 10.1186/s12889-020-09975-w, 21:1, Online publication date: 1-Dec-2021. Anadani M, Qureshi A, Menacho S, Grandhi R, Yaghi S, Jumaa M and de Havenon A (2021) Race/ethnicity and response to blood pressure lowering treatment after intracerebral hemorrhage, European Stroke Journal, 10.1177/23969873211046116, 6:4, (343-348), Online publication date: 1-Dec-2021. Sinnott S, Douglas I, Smeeth L, Williamson E and Tomlinson L (2020) First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care, BMJ, 10.1136/bmj.m4080, (m4080) Jacobs A, Pieters M and Schutte A (2020) The association of PAI-1 with 24 h blood pressure in young healthy adults is influenced by smoking and alcohol use: The African-PREDICT study, Nutrition, Metabolism and Cardiovascular Diseases, 10.1016/j.numecd.2020.07.003, 30:11, (2063-2071), Online publication date: 1-Oct-2020. Brownlow B, Williams D, Kapuku G, Vasey M, Anderson N, Koenig J, Thayer J and Hill L (2020) Ethnic Differences in Resting Total Peripheral Resistance: A Systematic Review and Meta-Analysis, Psychosomatic Medicine, 10.1097/PSY.0000000000000820, 82:6, (548-560), Online publication date: 1-Jul-2020. Parcha V, Patel N, Kalra R, Arora G and Arora P (2020) Prevalence, Awareness, Treatment, and Poor Control of Hypertension Among Young American Adults, Mayo Clinic Proceedings, 10.1016/j.mayocp.2020.01.041, 95:7, (1390-1403), Online publication date: 1-Jul-2020. López-Jaramillo P, Barbosa E, Molina D, Sanchez R, Diaz M, Camacho P, Lanas F, Pasquel M, Accini J, Ponte-Negretti C, Alcocer L, Cobos L, Wyss F, Sebba-Barroso W, Coca A and Zanchetti A (2019) Latin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome, Journal of Hypertension, 10.1097/HJH.0000000000002072, 37:6, (1126-1147), Online publication date: 1-Jun-2019. Schutte A, Gona P, Delles C, Uys A, Burger A, Mels C, Kruger R, Smith W, Fourie C, Botha S, Lammertyn L, van Rooyen J, Gafane-Matemane L, Mokwatsi G, Breet Y, Kruger H, Zyl T, Pieters M, Zandberg L, Louw R, Moss S, Khumalo I and Huisman H (2019) The African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT): Design, recruitment and initial examination, European Journal of Preventive Cardiology, 10.1177/2047487318822354, 26:5, (458-470), Online publication date: 1-Mar-2019. Faoro V and Forton K (2019) Pulmonary Vascular Reserve and Aerobic Exercise Capacity Interventional Pulmonology and Pulmonary Hypertension - Updates on Specific Topics [Working Title], 10.5772/intechopen.88399 Buendia J, Li Y, Hu F, Cabral H, Bradlee M, Quatromoni P, Singer M, Curhan G and Moore L (2018) Long-term yogurt consumption and risk of incident hypertension in adults, Journal of Hypertension, 10.1097/HJH.0000000000001737, 36:8, (1671-1679), Online publication date: 1-Aug-2018. El-shafie A, El-Gendy F, Allhony D, Abo El Fotoh W, Omar Z, Samir M, Bahbah W, Abd el naby S, El Zayat R, Abd El Hady N, El Gazar B, Zannoun M, Kasemy Z, El-Bazzar A, Abd El-Fattah M, Abd El-monsef A, Kairallah A, Raafet H, Baz G, Salah A and Galab W (2018) Establishment of blood pressure nomograms representative for Egyptian children and adolescents: a cross-sectional study, BMJ Open, 10.1136/bmjopen-2017-020609, 8:7, (e020609), Online publication date: 1-Jul-2018. Ferguson T, Younger-Coleman N, Tulloch-Reid M, Bennett N, Rousseau A, Knight-Madden J, Samms-Vaughan M, Ashley D and Wilks R (2018) Factors associated with elevated blood pressure or hypertension in Afro-Caribbean youth: a cross-sectional study, PeerJ, 10.7717/peerj.4385, 6, (e4385) Grech V (2017) Pregravid hypertension may have different secondary sex ratio effects in different races in the United States, International Journal of Cardiology, 10.1016/j.ijcard.2017.08.023, 248, (333-335), Online publication date: 1-Dec-2017. Chen S, Lo T, Chang J and Kuo H (2016) Ethnic Disparities in Blood Pressure: A Population-based Study, Journal of Immigrant and Minority Health, 10.1007/s10903-016-0434-y, 19:6, (1427-1433), Online publication date: 1-Dec-2017. Stephen I, Hiew V, Coetzee V, Tiddeman B and Perrett D (2017) Facial Shape Analysis Identifies Valid Cues to Aspects of Physiological Health in Caucasian, Asian, and African Populations, Frontiers in Psychology, 10.3389/fpsyg.2017.01883, 8 Colgrove P, Connell K, Lackland D, Ordunez P and DiPette D (2017) Controlling hypertension and reducing its associated morbidity and mortality in the Caribbean: implications of race and ethnicity, The Journal of Clinical Hypertension, 10.1111/jch.13056, 19:10, (1010-1014), Online publication date: 1-Oct-2017. Chang S, Yu Y, Carlsson N, Liu X and Colditz G (2017) Racial disparity in life expectancies and life years lost associated with multiple obesity-related chronic conditions, Obesity, 10.1002/oby.21822, 25:5, (950-957), Online publication date: 1-May-2017. Kapuku G, Treiber F, Raouane F, Halbert J, Davis H, Young-Mayes S, Robinson V and Harshfield G (2016) Race/ethnicity determines the relationships between oxidative stress markers and blood pressure in individuals with high cardiovascular disease risk, Journal of Human Hypertension, 10.1038/jhh.2016.39, 31:1, (70-75), Online publication date: 1-Jan-2017. Krishnadath I, Jaddoe V, Nahar-van Venrooij L and Toelsie J (2016) Ethnic differences in prevalence and risk factors for hypertension in the Suriname Health Study: a cross sectional population study, Population Health Metrics, 10.1186/s12963-016-0102-4, 14:1, Online publication date: 1-Dec-2016. Olsen M, Angell S, Asma S, Boutouyrie P, Burger D, Chirinos J, Damasceno A, Delles C, Gimenez-Roqueplo A, Hering D, López-Jaramillo P, Martinez F, Perkovic V, Rietzschel E, Schillaci G, Schutte A, Scuteri A, Sharman J, Wachtell K and Wang J (2016) A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension, The Lancet, 10.1016/S0140-6736(16)31134-5, 388:10060, (2665-2712), Online publication date: 1-Nov-2016. McGinnis D, Brownstein J and Patel C (2016) Environment-Wide Association Study of Blood Pressure in the National Health and Nutrition Examination Survey (1999–2012), Scientific Reports, 10.1038/srep30373, 6:1, Online publication date: 1-Sep-2016. Karbassi E, Monte E, Chapski D, Lopez R, Rosa Garrido M, Kim J, Wisniewski N, Rau C, Wang J, Weiss J, Wang Y, Lusis A and Vondriska T (2016) Relationship of disease-associated gene expression to cardiac phenotype is buffered by genetic diversity and chromatin regulation, Physiological Genomics, 10.1152/physiolgenomics.00035.2016, 48:8, (601-615), Online publication date: 1-Aug-2016. Dong F, Wang D, Pan L, Yu Y, Wang K, Li L, Wang L, Liu T, Zeng X, Sun L, Zhu G, Feng K, Zhang B, Xu K, Pang X, Chen T, Pan H, Ma J, Zhong Y, Ping B and Shan G (2016) Disparities in Hypertension Prevalence, Awareness, Treatment and Control between Bouyei and Han: Results from a Bi-Ethnic Health Survey in Developing Regions from South China, International Journal of Environmental Research and Public Health, 10.3390/ijerph13020233, 13:2, (233) Yuan M, Chen W, Teng B and Fang Y (2016) Occupational Disparities in the Association between Self-Reported Salt-Eating Habit and Hypertension in Older Adults in Xiamen, China, International Journal of Environmental Research and Public Health, 10.3390/ijerph13010148, 13:1, (148) Simaga B, Vicenzi M, Faoro V, Caravita S, Di Marco G, Forton K, Deboeck G, Lalande S and Naeije R (2015) Pulmonary vascular function and exercise capacity in black sub-Saharan Africans, Journal of Applied Physiology, 10.1152/japplphysiol.00466.2015, 119:5, (502-507), Online publication date: 1-Sep-2015. Zhao B, Jose P, Pu J, Chung S, Ancheta I, Fortmann S and Palaniappan L (2014) Racial/Ethnic Differences in Hypertension Prevalence, Treatment, and Control for Outpatients in Northern California 2010-2012, American Journal of Hypertension, 10.1093/ajh/hpu189, 28:5, (631-639), Online publication date: 1-May-2015. Heifetz E and Birk R (2014) MTHFR C677T Polymorphism Affects Normotensive Diastolic Blood Pressure Independently of Blood Lipids, American Journal of Hypertension, 10.1093/ajh/hpu152, 28:3, (387-392), Online publication date: 1-Mar-2015. Lackland D and Egan B (2015) Epidemiology Awareness, Prevalence, and Control: Newest Findings on Hypertension in Blacks Hypertension in High Risk African Americans, 10.1007/978-1-4939-2010-5_2, (21-33), . Mc Donald Posso A, Motta Borrel J, Fontes F, Cruz Gonzalez C, Pachón Burgos A and Cumbrera Ortega A (2014) High Blood Pressure in Panama, Medicine, 10.1097/MD.0000000000000101, 93:22, (e101), Online publication date: 1-Nov-2014. Lackland D (2014) Racial Differences in Hypertension: Implications for High Blood Pressure Management, The American Journal of the Medical Sciences, 10.1097/MAJ.0000000000000308, 348:2, (135-138), Online publication date: 1-Aug-2014. Carr D (2012) Racial and Ethnic Differences in Advance Care Planning, Journal of Aging and Health, 10.1177/0898264312449185, 24:6, (923-947), Online publication date: 1-Sep-2012. Kumar R and Einstein G (2012) Cardiovascular Disease in Somali Women in the Diaspora, Current Cardiovascular Risk Reports, 10.1007/s12170-012-0233-5, 6:3, (229-237), Online publication date: 1-Jun-2012. Kimura T, Senda S, Masugata H, Yamagami A, Okuyama H, Kohno T, Hirao T, Fukunaga M, Okada H and Goda F (2010) Seasonal Blood Pressure Variation and Its Relationship to Environmental Temperature in Healthy Elderly Japanese Studied by Home Measurements, Clinical and Experimental Hypertension, 10.3109/10641960902929479, 32:1, (8-12), Online publication date: 1-Feb-2010. Minor D, Wofford M and Jones D (2008) Racial and ethnic differences in hypertension, Current Atherosclerosis Reports, 10.1007/s11883-008-0018-y, 10:2, (121-127), Online publication date: 1-Apr-2008. Berenson G, Patel D, Wang H, Srinivasan S and Chen W (2008) Pressure–heart rate product changes from childhood to adulthood in a biracial population — a crossover phenomenon: the Bogalusa Heart Study, Journal of the American Society of Hypertension, 10.1016/j.jash.2007.08.007, 2:2, (80-87), Online publication date: 1-Mar-2008. December 19, 2006Vol 114, Issue 25 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.668731PMID: 17179032 Originally publishedDecember 19, 2006 KeywordsstressobesityhypertensionEditorialsPDF download Advertisement SubjectsEpidemiologyHypertensionObesity
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