Circulation 2000 Mar 14;101(10):1109-14
Myocardial infarction in treated hypertensive patients: the paradox
of lower incidence but higher mortality in young blacks compared with
whites.
Alderman MH, Cohen HW, Madhavan S.
Albert Einstein College of Medicine, Bronx, NY 10461, USA. alderman@aecom.yu.edu
BACKGROUND: Despite the impressive decline in coronary
heart disease death rates, a mortality differential between blacks and
whites persists. Our study objective was to determine whether excess mortality
among well-controlled hypertensive black men compared with whites is due
to differences in disease incidence or in case fatality.
METHODS AND RESULTS: Of 3382 male subjects (1266 blacks
and 2116 whites) enrolled between 1973 and 1996 and followed up through
1997 in a work-site hypertension control program, 2343 were followed up
until 60 years of age, and 1884 were followed up until >60 years of
age (either continuing after 60 years [n=845] or beginning treatment at
>/=60 years [n=1039]), with a mean follow-up of 5.2 and 5.5 years,
respectively. During follow-up, 186 myocardial infarction (MI) events
(including 31 revascularizations) occurred, with 63 in patients <60
years and 123 in patients >/=60 years of age. Age-adjusted MI incidence
was nearly twice as high for whites as blacks in younger (6.3 versus 3.4/1000
person-years) and older (14.1 versus 7.5 person-years) subjects. In contrast,
the age-adjusted case fatality rate was 3-fold higher for younger blacks
than for whites (37.8% versus 12.2%). In older patients, case fatality
did not differ significantly between blacks and whites (37.6% versus 50.
3%). In separate Cox regression analyses, among younger blacks but not
younger whites, history of diabetes and smoking were significantly associated
with both incidence and fatality.
CONCLUSIONS: In these treated male hypertensive patients
with good blood pressure control (139.6/85.7 mm Hg), young blacks, despite
a lower MI incidence, had higher MI mortality than did their white counterparts.
Their higher case fatality rate was associated with fewer coronary artery
revascularizations and a higher prevalence of diabetes and smoking.
PMID: 10715256 [PubMed - indexed for MEDLINE]
