14TL3893 Hypertension in populations of different ethnic origins

In their recent Editorial Hypertension: an urgent need for global control and prevention (May 31, p 1861),¹ Lancet Editors highlight the global need to address high blood pressure—the leading risk factor for mortality worldwide. This is particularly urgent in low-income and middle-income countries where prevalence is increasing. Present treatment guidelines, however, are largely based on white populations whereas evidence suggests that cardiovascular disease varies with ethnic origin.² South Asian populations, for example, have higher death rates from ischemic heart disease at young ages compared with populations in Western countries; Hispanic populations might achieve better blood pressure control with less treatment compared with non-Hispanic groups.^3,4 Thresholds for treatment, blood pressure targets, and antihypertensive regimens might differ between ethnic groups. Despite differences in general guidelines, the Eighth Joint National Committee (JNC8), American and International Societies of Hypertension, and European Society of Hypertension/ European Society of Cardiology all provided specific recommendations for blacks individuals.^5–7 Ethnic variations couldhave implications for polypills and other initiatives to streamline management in low-income and middle-income settings, such as the Global Standardized Hypertension Treatment Project [http://www.cdc.gov/globalhealth/ncd/hypertension-treatment.htm].

Good quality data on hypertension in different ethnic populations are missing. Of the more than 180 studies that met the JNC8's standards for inclusion, less than 30 include analysisof non-white, non-black groups.⁵ Generating high-quality evidence for diverse populations should become a priority. Prospective cohort studies and randomised controlled trials are needed to define how blood pressure should best be managed among the groups found in low-income and middle-income countries where the burden of hypertension is growing.