When it comes to cardiovascular diseases, the news is almost all bad for African-Americans.
Blacks are at least twice as likely as whites to suffer from high blood pressure. They also typically get it younger and have it treated less.
Compounding the problem, hypertension typically follows a far deadlier course in blacks than other people. In blacks, it is more likely to lead to kidney failure, strokes and deadly heart attacks.
"Hypertension is the No. 1 risk factor that precedes a whole series of problems that come cascading down the hill until we become Humpty Dumpty who fell off the wall," says Dr. Arthur Beau White. Dr. White is the new executive director of the Urban Medical Research Center, a West Baltimore research laboratory focusing on the health problems of African- Americans.
Doctors point out that stroke is almost an entirely preventable disease, but only if people control their high blood pressure. And blacks continue to suffer many strokes.
Moreover, while cardiovascular diseases are the No. 1 killer of both blacks and whites, the diseases are cutting a deadlier swath through the black population.
"We're in a heap of trouble and it's getting worse," Dr. White says.
Dr. White, who spent years working at the National Institutes of Health, says poverty, poor nutrition, poor health education, smoking, stress and, perhaps, a genetic predisposition to high blood pressure cause cardiovascular problems in the black population.
"The backdrop to all of these problems is a lack of proper nutrition, exercise and healthy living," Dr. White says. "But when you have other things going on in your life, you don't worry about cholesterol or whatever."
Interestingly, blacks seem to suffer more cardiovascular illnesses as they move into urban life.
This is true in the United States, where blacks suffered far fewer heart attacks than whites as recently as 30 years ago. That is no longer true.
Among blacks in places like Brazil, the Carribbean and Africa, in areas of rapid development and urbanization, doctors are noticing cardiovascular problems like high blood pressure and even once-rare heart attacks.
The culprits seem to be the same everywhere: relatively sedentary lifestyles, coupled with high-fat diets and bad habits.
"Too many people eat too much fat, things like red meat, dairy products, eggs, cheese and creams," says Dr. Elijah Saunders, head of the Hypertension Division at the University of Maryland Hospital and editor of a textbook, "Cardiovascular Diseases in Blacks."
People minimize their risk of heart problems by eating foods low in fats and salt, including fish that isn't fried, vegetables, fresh fruits, and lean chicken.
"As my grandfather said, 'You is what you eat,' " Dr. White says.
In addition to eating low-salt and low-fat foods, people also should limit sugar in their diets and exercise regularly to avoid cardiovascular problems.
"People sometimes say they work hard on their jobs, so they don't need to exercise," Dr. Saunders says. "But that's not going to do it. The type of exercise that benefits people is deliberate exercise, the type that raises the pulse rate for an extended period of time."
Also, being overweight is dangerous, he says.
"Black female obesity, especially, is a problem that contributes to cardiovascular problems," he says. "Obesity is not simply a matter of cosmetics, it is bad healthwise."
Contributing to all of these problems is a lack of health education among too many blacks.
"Look at all of the big anti-smoking campaigns," Dr. White says. "They have not had the kind of positive impact among black folk as they have among other groups of people."
Also, Dr. White says, in the upper reaches of the medical profession there is little interest in black health problems. That is reflected, he says, in the small number of research studies exploring black health concerns. It is no surprise, he says, that blacks are often the last to benefit from medical breakthroughs.
"The major medical research centers in the country do not think African-Americans are worthy of research," he says. "Look at the paucity of hard data relating to the diseases of African-Americans. But as my elders would say, 'Child, you got to do it yourself.' "