Black-white differences in the association between antihypertensive therapy, continuous measures of mean arterial and pulse pressures and left ventricular (LV) mass estimated from a multivariable electrocardiographic algorithm were examined in 6,020 men (23% black) and 7,970 women (29% black) participating in the Atherosclerosis Risk in Communities (ARIC) study. Mean arterial and pulse pressures, weight, the percentage of subjects taking antihypertensive medication, and LV mass were higher in black than in white men (98 vs 89 mm Hg, 47 vs 46 mm Hg, 188 vs 187 pounds, 30% vs 17%, and 243 vs 217 g, respectively). Results of similar direction but greater magnitude were observed in black versus white women (mean arterial pressure, 94 vs 85 mm Hg; pulse pressure, 50 vs 47 mm Hg; weight, 180 vs 153 pounds; percent treated, 42% vs 18%; and LV mass, 203 vs 169 g, respectively). In multivariable regression analyses, blacks had higher levels of LV mass, and LV mass increased more sharply with increasing mean arterial pressure in blacks than in whites after adjusting for age, pulse pressure, and weight. At equal mean arterial and pulse pressures, age, and weight, treated blacks had higher LV mass than treated whites. These data indicate that blacks have higher LV mass than whites, and a more pronounced blood pressure-LV mass relation after controlling for other risk factors and treatment status. Given the prognostic importance of LV hypertrophy, intensified efforts to understand the ethnic differentials in LV mass may provide strategies to reduce excess cardiovascular mortality in African-Americans.
Bibliographical noteFunding Information:
From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill; the Cardiac Epidemiology Coordinating & Research Center (Epicore), Division of Cardiology, University of Alberta, Edmonton, Canada, the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis; and the Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. This study was supported by contracts NOl-HC-55015,55016,55018,55019,55020,55021, and 55022 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and contract NC-92-FW-1 from the North Carolina American Heart Association, Chapel Hill. Manuscript received September 2,1993; revised manuscript received and accepted January 7, 1994.