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Background: Racial and gender differences influence control of coronary disease risk factors, and have often been related to socioeconomic issues.Methods: Encounters from a university-based primary cardiology clinic with broad referral base were analyzed for BP by race and gender in patients on antihypertensive medications.Results: A total of 200 encounters were examined: 53% (105) females; systolic BP (SBP) 134 ± 20 mmHg compared with 47% (95%) males; SBP 130 ± 18 mmHg (NS). There were 50% (100) African American; SBP 134 ± 20 mmHg compared with 50% (100) White patients; SBP 130 ± 18 mmHg (NS). Comparing each subgroup to the remainder of the patients revealed African American females (AAF) with SBP of 137 ± 21 mmHg (P < 0.01), White females with SBP 129 ± 19 mmHg (NS), African American males with SBP 128 ± 18 mmHg (NS), White males SBP 131 ± 18 mmHg (NS). Diastolic BP was 83 ± 13 mmHg in AAF compared with 78 ± 11 mmHg in the remaining groups (P < 0.01). Age, heart rate, LDL levels and weights in AAF were 59 ± 13 years, 70 ± 10 BPM, 91 ± 44 mg/dL and 214 ± 77 lbs compared with 61 ± 13 years, 70 ± 12 BPM, 88 ± 38 mg/dL and 209 ± 68 lbs respectively in the remaining patients (NS).Conclusion: Highest documented BP was observed in African American females with treated hypertension. Lack of compliance with medications is unlikely as these patients had insurance and their LDL levels were adequately controlled with medications. Slightly higher body weight in AAF, though not statistically significant, may have contributed to a higher BP. White-coat-hypertension is another potential explanation, which has been previously reported to be prevalent in African American females. Further studies with ambulatory BP monitoring may help better explain this observation. AAF remain at very risk for cardiovascular disease, and would benefit from efforts to improve detection and control of hypertension, in addition to other cardiac risk factors.