The effects of race and occupation on hypertension mortality.

American Negroes consistently show a higher prevalence of hypertension and greater morbidity and mortality from hypertensive disease than do American whites.l-7 In 1950, for the United States as a whole the male nonwhite-white mortality differential for hypertension was greater than that for any other cause of death except homicide and syphilis.93 Various hypotheses have been suggested to explain the race difference in hypertension: (1) the genetic hypothesis argues that Negroes are genetically different from whites in ways that predispose more of them to hypertension;4,5'9 10 (2) the physical exertion hypothesis argues that Negroes are more likely than whites to be engaged in manual labor occupations and that greater physical exertion leads to higher mortality from hypertension;4 (3) the associated disorder hypothesis argues that Negroes are more prone to diseases such as pyelonephritis and syphilis, which may result in secondary hypertension;4'11 (4) the psychological stress hypothesis argues that Negroes are severely frustrated by racial discrimination and that this stress and the repressed aggression associated with it lead to a higher prevalence of hypertension;4 11,12 (5) the diet hypothesis argues that Negroes may have dietary patterns that increase their susceptibility to hypertension;"l, 3-15 (6) the medical care hypothe-