Socioecologic stress and hypertension related mortality rates in North Carolina.

Prior research' 2 has shown that black Americans tend to have higher mean blood pressure levels than their white compatriots and that the death rate due to hypertension and related disorders (e.g., hypertensive heart disease and strokes) is considerably higher among blacks than whites. The reasons for these differences are not fully understood, although most researchers attribute them to a combination of genetic and socio-environmental factors, including differential access to good medical care. With blacks comprising nearly 96 per cent of the total nonwhite population in the state, the nonwhite-white difference in hypertension related mortality in North Carolina either remained at an extremely high level or increased during the 1960-70 decade. For example, in 1960 the age-adjusted hypertension death rate among the state's nonwhite males, age 45-64, was 4.8 times greater than that for whites. By 1970, this ratio had increased to 6.2. Among females, the hypertension death rate in this same group was 8.3 times higher among nonwhites in 1960 but had declined to 4.6 by 1970. In the case of cerebrovascular accidents, the nonwhite death rate was 3 to 4 times higher than that for whites for both time periods and for both sexes. Such gross differences in health between two groups of people represent a very serious public health problem for the state of North Carolina since findings from the Veterans Administration controlled clinical trials3' 4 on the efficacy of antihypertension medication imply that broad, carefully planned secondary prevention efforts might reduce significantly the number of hypertension related deaths in the nonwhite population of this state. Important as these secondary prevention efforts are,