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A review of original and published data yields the consistent finding that chronic hypertension is endemic and prevalent throughout the Caribbean area. The prominent involvement of genetics is suggested in several lines of evidence, including significant ethnic differences in blood pressure values, higher incidence in smaller isolated island populations, the discovery of polymorphic blood proteins that appear to be linked to hypertension susceptibility, and the slavery hypothesis of natural selection favoring a salt-conserving physiology in ancestral populations. Environmental factors—climatic, demographic, and cultural—exert strong influences on blood pressure levels and hypertension etiology in the Caribbean. Salt intake and other dietary behaviors, degree of community awareness of the disease, and differential treatment modalities are related to hypertension epidemiology in indigenous and migrant Caribbean populations. The traditional use of medicinal plants, historically successful in part because of the beneficial bioactivity of many antihypertensive phytochemical components, has been recently supplemented with the widespread introduction of synthetic biomedical drugs. Prospective research strategies are recommended that might further elucidate the complex gene-environment interactions contributing to blood pressure variation and hypertension patterns in the Caribbean region.