Hypertensive kidney disease in African Americans

SUMMARY: End‐stage renal disease is a significant public health problem in both developed and developing countries. The magnitude and pattern of renal disease varies between countries. This variability could probably be explained by the racial and ethnic composition. The United States is a typical example, showing significant racial and ethnic differences in the magnitude and pattern of renal disease. African Americans, Native Americans and Pacific Islanders are disproportionately afflicted with end‐stage kidney failure (ESRD), compared with Caucasians and Asians. Whereas diabetes mellitus, primarily type 2, is the predominant cause of renal disease (and ESRD) in the US, and prominently in Native Americans, hypertensive kidney disease is the most prevalent cause of ESRD in African Americans. Some of the suggested reasons for the increased incidence and prevalence of hypertensive kidney disease in African Americans include the higher prevalence and severity of hypertension, especially in the early years of life, lower socio‐economic status leading to inadequate health care, a greater propensity towards developing intrinsic renal vascular disease, a greater tendency towards developing target organ damage at ‘normal’ blood pressure levels, and the use of drugs that are less renoprotective to treat their blood pressure.