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.