STUDY OF THE KIDNEY IN THE BANTU WITH HYPERTENSION

New insights on the risk for cardiovascular disease in African Americans: the role of added sugars

African Americans are at increased risk for cardiovascular and metabolic diseases, including obesity, high BP, diabetes, CKD, myocardial infarction, and stroke. Here we summarize the current risks and provide an overview of the underlying risk factors that may account for these associations. By reviewing the relationship between cardiovascular and renal diseases and the African-American population during the early 20th century, the historic and recent associations of African heritage with cardiovascular disease, and modern population genetics, it is possible to assemble strong hypotheses for the primary underlying mechanisms driving the increased frequency of disease in African Americans. Our studies suggest that underlying genetic mechanisms may be responsible for the increased frequency of high BP and kidney disease in African Americans, with particular emphasis on the role of APOL1 polymorphisms in causing kidney disease. In contrast, the Western diet, particularly the relatively high intake of fructose-containing sugars and sweetened beverages, appears to be the dominant force driving the increased risk of diabetes, obesity, and downstream complications. Given that intake of added sugars is a remediable risk factor, we recommend clinical trials to examine the reduction of sweetened beverages as a primary means for reducing cardiovascular risk in African Americans.

The pathology of hypertension in a tropical environment

Hypertension is very common in blacks and occurs at a younger age than in whites. It behaves in an explosive manner with death occurring frequently from cerebral hemorrhage, uremia or congestive heart failure. Pathologically the majority have essential hypertension. The development of hypertension is related to urbanization and Westernization, as the incidence in rural blacks is low. Despite the high incidence of hypertension, myocardial infarction remains infrequent.