In summary, the black patient with hypertension represents a challenge. This pathophysiologic state exists with much greater prevalence than in the nonblack population. The exact reasons for this are unknown, but because tribal blacks in Africa do not have hypertension, one might speculate that alterations in life-style, including increased stress and dietary alterations, play a large role. The black hypertensive patient also appears to differ from the white hypertensive patient in that he/she shows a tendency to volume expansion, low renin state, early nephrosclerosis, and lowered renal blood flow. Other parameters of the advanced hypertensive state, such as lowered cardiac output and increased total peripheral resistance, seem to be in common with the white patient with hypertension. The black patient is also unique in that he/she demonstrated less response to beta-adrenergic blocking agents and seems to require diuretic therapy under most circumstances. These considerations, as well as a discussion of appropriate therapy in black and white hypertensive patients, need to be considered in further detail.