Racial differences in ambulatory blood pressure monitoring-derived 24 h patterns of blood pressure in adolescents

Background. Many pathologic conditions are characterized by a blunted nocturnal decline in blood pressure. Objective. To review the evidence that African Americans display a similar pattern and examine factors associated with the pattern. Method. We reviewed published racial comparisons of patterns of ambulatory blood pressure in adults and youths. Results. Authors of 15 studies reported finding blunted nocturnal declines in African Americans and authors of two studies did not. Authors of studies of Africans in Africa and of 'blacks' from other countries reported normal nocturnal declines. Both intake of sodium and indexes of body size have been related to nocturnal blood pressure in African-American youths. This pattern is related to greater than normal target-organ changes. Conclusion. We conclude that the race of a patient should be considered when evaluating a 24 h pattern of blood pressure in an adolescent; and the blunted nocturnal decline displayed by many African-American adolescents is the result of a gene-environment interaction and therefore is susceptible to modification through changes in diet, level of activity, and other environmental factors.