• Thierry Gombet, Olivier Steichen, and Pierre-François Plouin.
• Unité d'hypertension artérielle, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris cedex 15.
• B Acad Nat Med Paris. 2007 Nov 1;191(8):1745-54; discussion 1754-5.

AbstractHypertensive disease is reported to be more severe in black patients than in white patients, but most available data concern African-Americans. We studied blood pressure history and levels, the prevalence of associated risk factors, renal and cardiovascular complications, and secondary forms of hypertension in patients born in sub-Saharan Africa and managed in France, by comparison with up to five control patients born in Europe and matched for age and sex. Compared to European hypertensive women, African hypertensive women had a higher body-mass index (28.8 vs 26.3 kg/m2, p<0.001) and were more often diabetic (12 vs 5%, p<0.001). Hypertensive men and women born in sub-Saharan Africa had higher systolic blood pressure (152 vs 148 mmHg, p<0.001), were more likely to have a history of stroke (11.7 vs 6.7%, p<0.001) and were less likely to have a history of smoking or hyperlipidemia than European controls. Sub-Saharan Africans were more frequently given antihypertensive medication than their paired controls (84 vs 74%, p<0.001), and their antihypertensive regimens were more likely to include a diuretic (54 vs 46%, p=0.001) or a calcium channel antagonist (58 vs 49%, p=0.001). Compared to European controls, patients born in sub-Saharan Africa had more frequent proteinuria (test strip positivity : 32 vs 18%, p<0.001), irrespective of blood pressure and diabetes. The overall prevalence of secondary hypertension was similar in the two populations. However, patients born in sub-Saharan Africa were more likely than their European controls to have primary hyperaldosteronism (12 vs 7%, p=0.001) and less likely to have renovascular disease (1 vs 5%, p=0.001). Thus, the higher prevalence of cardiovascular and renal complications at referral among patients born in sub-Saharan Africa relative to age- and sex-matched European patients does not seem to be explained solely by observed differences in blood pressure or associated risk factors. The difference in the distribution of secondary hypertension warrants further study.

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