Genetic, environmental, and lifestyle factors, precision medicine components, influence African Americans’ cardiovascular health. Genetic studies have identified correlations between African American populations and specific cardiovascular disease biomarkers, including those related to inflammation, thrombosis, salt sensitivity, hypertension, lipid profiles, arrhythmias, and left ventricular mass. Genome-wide association studies have explored genetic relationships to cardiac risk factors, including hypertension and inflammation biomarkers, suggesting an inherent predisposition to these conditions. Moreover, hypertension, a critical risk factor for cardiovascular disease, has been shown to have a heritable component. Studies indicate that 15% to 35% of the correlation in hypertension could be inherited. There are also several significant differences in African Americans’ clinical care, including specific medication choices, disease control management, and alternative treatment approaches. Applying these research-verified clinical management regimes can ensure a more efficient path to patient success and positively benefit outcomes. For example, hypertension therapy should be initiated with consideration of medication differences. African Americans have more favorable lipid profiles, but they suffer from disproportionately higher cardiovascular disease. African Americans also exhibit a prothrombotic tendency that increases the risk for stroke, myocardial infarction, deep vein thrombosis, and pulmonary embolism. Curiously, African Americans have a lower risk for atrial fibrillation. Because of the increased risk for stroke when a fib exists, this has been labeled a “racial paradox.” Other cardiovascular precision-care-related recommendations beneficial to African Americans are reviewed.