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(Hypertension. 1998;31:1070-1076.)
© 1998 American Heart Association, Inc.

Scientific Contributions

Hypertensive Vascular Disease as a Cause of Death in Blacks Versus Whites

Autopsy Findings in 587 Adults

Anekwe Onwuanyi; David Hodges; Amarnath Avancha; Linda Weiss; Daniel Rabinowitz; Steven Shea; ; Charles K. Francis

From the Division of Cardiology and Department of Medicine, Harlem Hospital Center (A.O., D.H., A.A., C.K.F.); the Divisions of Cardiology (D.H.) and General Medicine (L.W., S.S.), Department of Medicine, Columbia University College of Physicians and Surgeons; the Department of Statistics, Columbia University (D.R.); and the Division of Epidemiology, Columbia University School of Public Health (S.S.), New York, NY.

Correspondence to Dr Charles K. Francis, Department of Medicine, Room 14–401, Harlem Hospital Center, 506 Lenox Ave, New York, NY 10037.

Abstract—Cardiovascular disease is the major cause of excess mortality among urban US blacks, but autopsy data comparing black-white differences in underlying pathological causes of cardiovascular death are lacking. We reviewed all 720 adult cases autopsied in 1991 in the New York City Medical Examiner's Office in which the coded cause of death was cardiovascular disease (International Classification of Diseases, 9th Revision, codes 391, 393 to 398, 401 to 404, 410, 411, 414 to 417, 420 to 438, and 440 to 444). After exclusion of 133 cases because race was missing or coded as other than black or white, gender was not coded, or there was an unusual circumstances of death or extreme obesity, 587 cases were available for analysis. There were 314 black and 273 white subjects. Black women were younger than white women at time of death (mean age, 54.7 versus 61.5 years; P<.001), whereas black and white men did not differ in mean age at death. Hypertensive vascular disease was the autopsy cause of death in 42% of blacks compared with 23% of whites (P<.001). Conversely, atherosclerotic heart disease was the autopsy cause of death in 64% of white subjects but only 38% of blacks. These patterns were consistent in both sexes and after adjustment for age. Hypertensive vascular disease was far more common than atherosclerotic heart disease as the cause of death at autopsy among blacks compared with whites in New York City, whereas atherosclerotic heart disease was more common in whites. These findings suggest that ineffective control of hypertension is a major factor contributing to excess cardiovascular mortality among urban blacks.

Key Words: atherosclerosis • autopsy • cardiovascular diseases • race

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