Journal of Primary Care & Community Health XX(X) 1 –6 © The Author(s) 2010 Reprints and permission:

accounting for the majority of adult ambulatory office visits within family medicine practices.2 Hypertension is currently defined as blood pressure> 140/90 mm Hg.3 Evidence has shown that improved control of hypertension has a positive impact on reducing cardiovascular disease,4-6 yet from 1991 to 2001, the number of deaths due to hypertension in the United States rose by 53%.3 Half of all patients who experi-ence first-time myocardial infarctions, and two-thirds of all patients who experience initial strokes, have blood pres-sures> 140/90 mm Hg. Additionally, high blood pressure is a major comorbid predictor of heart failure, preceding the diagnosis in>75 % of cases. The financial burden of hyper-tension is staggering. The estimated total costs exceeded $73 billion in 2009.7 Heart disease and stroke, the number 1 and 3 causes of death in African Americans, are directly related to uncon-trolled hypertension.8 African Americans have coronary artery disease, heart failure, stroke, and diabetes at rates disproportionately higher than Caucasians.4,7,9,10 Ninety-five percent of cases of hypertension are essential hyperten-sion, with a typical onset after the second decade of life.11 African American women have hypertension at dispropor-tionate rates, with 42.4 % of women and 38.6 % of men hav-ing hypertension compared with 27.6 % of women and 28.2 % men among Caucasians.12 The reasons for this dis-parity are the subject of intense debate. Although not clearly understood, an increase in sodium sensitivity among African Americans may account for part of the hypertensio