Divergence with age in blood pressure in African-Caribbean and white populations in England: implications for screening for hypertension

Am J Hypertens. 2012 Jan;25(1):89-96. doi: 10.1038/ajh.2011.160. Epub 2011 Sep 1.


Background: We assessed when blood pressure (BP) and hypertension begin to rise in African-Caribbeans compared to the white population; and whether the change relates to body mass index (BMI).

Methods: Secondary analysis of the cross-sectional Health Surveys for England among 22,723 participants (21,344 whites and 1,379 African-Caribbeans) adults aged ≥18 years.

Results: The cubic spline graphs showed a crossover (African-Caribbean greater than whites) at 30-40 years in BP. Age-specific mean BP and hypertension prevalence data showed at 20-29 years African-Caribbean men were advantaged but not thereafter. There was little difference in BMI in men. African-Caribbean women had lower systolic BP (but higher prevalence of hypertension) at 20-29 years but higher BP and prevalence of hypertension thereafter. African-Caribbean women had higher BMI than white women. Regression showed an age and ethnicity interaction for systolic (0.076 mm Hg greater increase per year, P = 0.054) and diastolic BP (0.068 mm Hg greater increase per year (P = 0.009) and hypertension (OR equals 1.02, P = 0.004) in African-Caribbean men, and diastolic BP in African-Caribbean women (0.057 mm Hg greater increase per year, P = 0.017). Crossover was 28, 44, and 28 years for systolic BP, diastolic BP and hypertension in men, respectively; and 40 years for diastolic BP in women.

Conclusions: Clinicians should be extra vigilant about screening African-Caribbean patients from the age of 30 years. Detailed study is needed to understand the still mysterious mechanisms for this crossover.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Blacks / statistics & numerical data
  • Blood Pressure / physiology*
  • Blood Pressure Determination
  • Body Mass Index
  • Caribbean Region / ethnology
  • England / epidemiology
  • Ethnicity / statistics & numerical data
  • Female
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology*
  • Male
  • Prevalence
  • Whites / statistics & numerical data