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Hypertension in African Americans: a paradigm of metabolic disarray.

Hypertensive disease in African Americans manifests itself at an earlier age, tends to be more aggressive and difficult to treat, and is more likely to be associated with renal failure. Abnormalities of carbohydrate metabolism, specifically tissue insulin resistance, may underlie the constellation of clinical and pathophysiological characteristics commonly observed in African American hypertensive subjects. The interrelationships between insulin resistance, salt sensitivity, and vascular hyperresponsitivity to adrenergic stimuli require further clinical study, because this relationship may not only partly explain much of the hypertensive disease observed in African Americans, but may also help identify appropriate therapeutic interventions.