Now if we had a functioning stroke association this could have been solved years ago. Dr. Sacco, Mr Baranski; Care to comment?
http://www.medpagetoday.com/Cardiology/Hypertension/36379?
Compared with whites, blacks have a greater stroke risk for a given
increase in systolic blood pressure, but it may have less to do with
race than risk factors, researchers found.
Among individuals 45 and older, a 10-mm Hg elevation in systolic
blood pressure was associated with an 8% relative increase in stroke
risk for whites and a 24% increase for blacks (P=0.02), according to George Howard, DrPH, of the University of Alabama at Birmingham, and colleagues.
The difference tended to be greater among those younger than 65, the researchers reported online in Archives of Internal Medicine.
"When these racial differences are coupled with the previously
documented higher prevalence of hypertension and poorer control of
hypertension in blacks, they may account for much of the racial
disparity in stroke risk," they wrote.
It has been well established that stroke risk is higher in blacks
than in whites, but traditional risk factors explain only about half of
the difference. One potential explanation for the rest of the variance
is that certain risk factors affect blacks and whites differently, a
possibility explored in the current study.
Howard and colleagues looked at data from 27,748 black and white
individuals participating in the Reasons for Geographic and Racial
Differences in Stroke (REGARDS) study, which over-samples blacks and
residents of the Stroke Belt in the southeastern U.S.
All of the participants were free from stroke at baseline. Through an
average of 5.6 years of follow-up, there were 715 incident strokes.
The stroke risk associated with a 10-mm Hg increase in systolic blood
pressure was greater in blacks than in whites, particularly among those
ages 45 to 64.
In that younger age group, stroke risk was not significantly
different between the races among those with a normal blood pressure
(less than 120 mm Hg). There was a trend, however, for a greater risk in
blacks among those with prehypertensive readings of 120 to 139 mm Hg
(HR 1.38, 95% CI 0.94 to 2.02).
Among those with stage 1 hypertension (140 to 159 mm Hg), the stroke
risk was significantly greater in blacks (HR 2.38, 95% CI 1.19 to 4.72)
after adjustment for sex and use of antihypertensive medications.
The findings were largely consistent after further adjustment for
traditional stroke risk factors, including diabetes, atrial
fibrillation, left ventricular hypertrophy, heart disease, and current
cigarette smoking.
There were less striking racial differences observed in the older age groups.
"These data suggest that black-white disparities would be virtually
eliminated if normotension were achieved across all groups and that
improvements in hypertension control across the board would be expected
to narrow or eliminate the observed disparities," according to Anthony
Kim, MD, and S. Claiborne Johnston, MD, PhD, of the University of
California San Francisco.
In addition, they wrote in an accompanying editorial, "this study
highlights the possibility that interventions targeting young blacks may
be particularly efficient, since a given reduction in systolic blood
pressure would be predicted to translate into disproportionate
improvements in health outcomes, at least if one assumes that the level
of risk among those achieving normotension is similar to those who were
normotensive to begin with."
Although achieving greater blood pressure control among blacks would
likely result in substantial reductions in strokes, deaths, and
healthcare costs, it may not be easy, Kim and Johnston said.
"Effective interventions must take into account the limitations of
race/ethnic categories and, more importantly, they must respect the
biosocial complexity upstream of hypertension control," they wrote. "But
there is reason to believe that innovative high-quality research,
targeted and creative interventions, and social and systemic change will
lead to measurable progress in reducing and eliminating these
disparities moving forward ... ."
University of Alabama researchers presented similar findings in
November at the American Heart Association meeting regarding the risk of
coronary artery disease in blacks. They concluded that the high risk of heart disease may be more a matter of the burden of risk factors than of race.
Howard and colleagues acknowledged that their analysis was limited in
that it relied on major stroke risk publications to identify
traditional risk factors. Other factors not included may explain some of
the observed racial differences.
In addition, exposures were measured at baseline, so the researchers could not account for changes over time.
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