Logo of heartHeartVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Heart. Mar 2000; 83(3): 267–271.
PMCID: PMC1729353

Racial variation in cardiovascular morbidity and mortality in essential hypertension


OBJECTIVES—To perform a longitudinal comparison of morbidity and mortality among white, south Asian and Afro-Caribbean hypertensive patients in relation to baseline demographic characteristics and clinic and ambulatory blood pressure variables.
DESIGN—Observational follow up study.
SETTING—District general hospital and community setting in Harrow, England.
PATIENTS—528 white, 106 south Asian, and 54 Afro-Caribbean subjects with essential hypertension who had undergone 24 hour ambulatory intra-arterial blood pressure monitoring.
INTERVENTIONS—Follow up for assessment of all cause morbidity and mortality over a mean (SD) of 9.2 (4.1) years.
MAIN OUTCOME MEASURES—Non-cardiovascular death, coronary death, cerebrovascular death, peripheral vascular death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularisation.
RESULTS—South Asians had the highest all cause event rate of 3.46, compared with 2.50 (NS) and 0.90 (p = 0.002) events/100 patient-years for whites and Afro-Caribbeans, respectively. This was because of an excess of coronary events (2.86 v 1.32 events/100 patient-years in south Asians v whites, respectively; p = 0.002). Age (p < 0.001), sex (p < 0.001), race (south Asians : whites, hazard ratio 1.79; p = 0.008), diabetes (p = 0.05), previous history of cardiovascular disease (p < 0.001), and 24 hour ambulatory systolic blood pressure (p = 0.006) were independent predictors of time to a first event. Clinic blood pressure did not provide additional prognostic information.
CONCLUSIONS—South Asian origin was an independent predictor of all cause events, mainly because of an excess of coronary events in this group. Ambulatory but not clinic blood pressure was of additional value in predicting subsequent morbidity and mortality.

Keywords: race; hypertension; prognosis; ambulatory blood pressure

Full Text

The Full Text of this article is available as a PDF (98K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P. Prevalence, detection, and management of cardiovascular risk factors in different ethnic groups in south London. Heart. 1997 Dec;78(6):555–563. [PMC free article] [PubMed]
  • Raleigh VS. Diabetes and hypertension in Britain's ethnic minorities: implications for the future of renal services. BMJ. 1997 Jan 18;314(7075):209–213. [PMC free article] [PubMed]
  • Meade TW, Brozović M, Chakrabarti R, Haines AP, North WR, Stirling Y. Ethnic group comparisons of variables associated with ischaemic heart disease. Br Heart J. 1978 Jul;40(7):789–795. [PMC free article] [PubMed]
  • Díez J, Alonso A, Garciandía A, López R, Gómez-Alamillo C, Arrázola A, Fortuño A. Association of increased erythrocyte Na+/H+ exchanger with renal Na+ retention in patients with essential hypertension. Am J Hypertens. 1995 Feb;8(2):124–132. [PubMed]
  • Clement DL, De Buyzere M, Duprez D. Prognostic value of ambulatory blood pressure monitoring. J Hypertens. 1994 Aug;12(8):857–864. [PubMed]
  • Perloff D, Sokolow M, Cowan R. The prognostic value of ambulatory blood pressures. JAMA. 1983 May 27;249(20):2792–2798. [PubMed]
  • Verdecchia P, Porcellati C, Schillaci G, Borgioni C, Ciucci A, Battistelli M, Guerrieri M, Gatteschi C, Zampi I, Santucci A, et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension. 1994 Dec;24(6):793–801. [PubMed]
  • Acharya DU, Heber ME, Doré CJ, Raftery EB. Ambulatory intraarterial blood pressure in essential hypertension. Effects of age, sex, race, and body mass--the Northwick Park Hospital Database Study. Am J Hypertens. 1996 Oct;9(10 Pt 1):943–952. [PubMed]
  • Millar-Craig MW, Bishop CN, Raftery EB. Circadian variation of blood-pressure. Lancet. 1978 Apr 15;1(8068):795–797. [PubMed]
  • Cashman PM, Stott FD, Craig MW. Hybrid system for fast data reduction of long-term blood-pressure recordings. Med Biol Eng Comput. 1979 Sep;17(5):629–635. [PubMed]
  • Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F, Porcellati C. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation. 1990 Feb;81(2):528–536. [PubMed]
  • Mather HM, Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br Med J (Clin Res Ed) 1985 Oct 19;291(6502):1081–1084. [PMC free article] [PubMed]
  • Omar MA, Seedat MA, Dyer RB, Rajput MC, Motala AA, Joubert SM. The prevalence of diabetes mellitus in a large group of South African Indians. S Afr Med J. 1985 Jun 8;67(23):924–926. [PubMed]
  • Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ. 1991 Mar 9;302(6776):560–564. [PMC free article] [PubMed]
  • McKeigue PM, Miller GJ, Marmot MG. Coronary heart disease in south Asians overseas: a review. J Clin Epidemiol. 1989;42(7):597–609. [PubMed]
  • McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991 Feb 16;337(8738):382–386. [PubMed]
  • McKeigue PM, Marmot MG, Syndercombe Court YD, Cottier DE, Rahman S, Riemersma RA. Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London. Br Heart J. 1988 Nov;60(5):390–396. [PMC free article] [PubMed]
  • Knight TM, Smith Z, Whittles A, Sahota P, Lockton JA, Hogg G, Bedford A, Toop M, Kernohan EE, Baker MR. Insulin resistance, diabetes, and risk markers for ischaemic heart disease in Asian men and non-Asian in Bradford. Br Heart J. 1992 May;67(5):343–350. [PMC free article] [PubMed]
  • Bhatnagar D, Anand IS, Durrington PN, Patel DJ, Wander GS, Mackness MI, Creed F, Tomenson B, Chandrashekhar Y, Winterbotham M, et al. Coronary risk factors in people from the Indian subcontinent living in west London and their siblings in India. Lancet. 1995 Feb 18;345(8947):405–409. [PubMed]
  • Anand SS, Enas EA, Pogue J, Haffner S, Pearson T, Yusuf S. Elevated lipoprotein(a) levels in South Asians in North America. Metabolism. 1998 Feb;47(2):182–184. [PubMed]
  • Mancia G, Zanchetti A, Agabiti-Rosei E, Benemio G, De Cesaris R, Fogari R, Pessina A, Porcellati C, Rappelli A, Salvetti A, et al. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. SAMPLE Study Group. Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation. Circulation. 1997 Mar 18;95(6):1464–1470. [PubMed]

Figures and Tables

Figure 1
Follow up scheme for the 723 study patients.
Figure 2
Baseline and follow up clinic blood pressures in white, south Asian, and Afro-Caribbean subjects.
Figure 3
Incidence of non-cardiovascular, coronary, and cerebrovascular events in white, south Asian, and Afro-Caribbean subjects. *p < 0.01 v Afro-Caribbeans; **p < 0.01 v whites and Afro-Caribbeans.

Articles from Heart are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...