Young African Americans have a 2-3 fold greater likelihood of having an ischemic stroke, suffer greater physical disability after a stroke, and adults are more likely to die from a stroke than are members of other major racial groups in the US that have been studied. Risk is increased for both ischemic and hemorrhagic strokes. The estimated age-adjusted prevalence of stroke is greater in African American women than in men. Up to 40% of adult African Americans have hypertension, almost twice as many as adult Hispanic and non-Hispanic whites. The form of hypertension in many African Americans may have an earlier onset, be more severe, and be more sensitive to dietary salt intake than that seen in the other groups.  (Recently, a gene has been described that may be responsible for this increased salt sensitivity but much remains to be investigated.) The prevalence of physician-diagnosed diabetes in African American adults age 20 and older is 7.6% of men and 9.5% of women (in non-Hispanic whites the prevalence is 5.4% of men and 4.7% of women). However, in at least one study, the relative risk of stroke among African Americans was higher, even when the statistics were adjusted for age, hypertension, and diabetes. In African Americans, atherosclerotic plaque tends to deposit more often in the intracranial branches of the major arteries, especially the carotid, while extracranial lesions occur more frequently in whites. The significance of this difference is unclear at present. African Americans who live in the so-called Stroke Belt in the southeast US have the highest death rates from stroke in the US. The Stroke Belt includes Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia.  Although not a state, Washington DC has also been identified as part of the Stroke Belt.  In addition, African Americans living in these regions have the greatest prevalence of high blood pressure.  Whites who live in the Stroke Belt also have somewhat increased incidence of hypertension and stroke. In the US, most people with sickle cell disease are African-American.  Sickle cell disease is strongly associated with stroke, especially in children.  In these individuals, the vascular endothelium may be damaged by repeated episodes of red cell sickling, making it prone to thrombus formation. Long-term exchange transfusion or bone marrow transplants can prevent the vascular pathology from progressing, and therefore decrease the risk of stroke. If a child with sickle cell disease has a stroke, he or she often recovers quite well, thanks perhaps to the increased plasticity of the young nervous system. However, without therapy these children remain at high risk for additional strokes that may produce a lifetime of disability.