© Springer Science+Business Media New York 2015. Stroke is a leading cause of death but is preventable. Despite the overall decline of stroke mortality in the past 50 years, it has remained consistently higher in blacks than any other race/ethnic group. Research shows that approximately half of the excess black-to-white disparity in stroke risk is attributable to traditional stroke risk factors, primarily hypertension and diabetes. In addition to higher prevalence of hypertension in blacks, evidence supports that blacks are less likely to have their blood pressure controlled than whites. Recent data show that the impact of uncontrolled hypertension on stroke risk is three times greater for blacks than whites. Ambulatory BP monitoring has uncovered a variety of abnormalities that may predict stroke and are more prevalent in blacks, including masked hypertension, the nocturnal BP pattern, and circadian BP variability. With knowledge of the causes of the reasons for excess risk, interventions can be designed and implemented to reduce the unequal burden of stroke.