Young, urban, African American men are at particularly high risk of
hypertension and its cardiovascular complications.
Left ventricular hypertrophy and renal dysfunction are manifestations of target organ damage from
hypertension that predict adverse cardiovascular events. The subjects of this study were 309 African American men, age 18-54 years, with
hypertension, residing in inner-city Baltimore. Echocardiograms, electrocardiograms, serum
creatinine, and the urinary
albumin-
creatinine ratio were obtained to evaluate hypertensive target organ damage. Fifty-three percent of the men reported use of
antihypertensive medications, of whom 80% were on monotherapy.
Calcium channel blockers were used most frequently. The mean echocardiographic left ventricular mass was 211+/-68 g, with a prevalence of echocardiographic
left ventricular hypertrophy of 30%. There were 14 men (5%) with extremely high left ventricular mass, >350 grams.
Left ventricular systolic dysfunction was seen in 9% of the men with uncontrolled
hypertension, and none of the men with controlled
hypertension (p=0.02). Renal dysfunction was found in 12% of the subjects, and microalbuminuria or gross
proteinuria in 34%. The authors conclude that there is a high prevalence of cardiac and renal abnormalities in inner-city African American men with
hypertension, especially in men on
antihypertensive therapy with uncontrolled
hypertension. It is imperative that cost-effective medications and culturally acceptable health care delivery programs be developed, tested, and integrated into health systems, with strategies specifically relevant to this high-risk population, to decrease the largely preventable morbidity and mortality associated with
hypertension.