Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Excess Hypertension Risk in Black Adults

JAMA; 2018 Oct 8; Howard, Cushman, et al

The largest statistical mediator of the difference in hypertension incidence between black and white US adults was the Southern dietary pattern, a recent study found. The mediation analysis compared incident hypertension among 6,897 individuals (mean age 62 years; 26% black adults, 55% women) without hypertension at baseline (2003-2007) and participating in a follow-up visit 9.4 years (median) later. Researchers found:

  • The Southern dietary pattern was the largest mediating factor for differences in the incidence of hypertension, accounting for 51.6% of the excess risk among black men and 29.2% of the excess risk among black women.
  • Among black men, a higher dietary ratio of sodium to potassium and an education level of high school graduate or less each mediated 12.3% of the excess risk of incident hypertension.
  • Among women, waist circumference and body mass index were also key factors.


Howard G, Cushman M, Moy CS, et al. Association of clinical and social factors with excess hypertension risk in black compared with white US adults. JAMA. 2018;320(13):1338–1348. doi:10.1001/jama.2018.13467.

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