Treatment of hypertension in blacks
- Brent M Egan, MD
Brent M Egan, MD
- Professor of Medicine
- University of South Carolina School of Medicine-Greenville
- Medical Director, Care Coordination Institute
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
Hypertension is a major problem in black patients; the incidence and prevalence of cardiovascular and renal complications of hypertension are greater than in other race/ethnicity groups. The adjusted relative risk of stroke, for example, is more than twice as high in hypertensive blacks aged 45 to 64 years as compared with similarly aged hypertensive whites (table 1) . As a result, effective antihypertensive therapy is particularly important in these patients . (See "Hypertensive complications in blacks".)
According to the 2010 recommendations from the International Society on Hypertension in Blacks , antihypertensive therapy is recommended for blacks without target-organ damage or concomitant cardiovascular diseases at blood pressures greater than 135/85 mmHg and, for those at higher risk, at blood pressures greater than 130/80 mmHg. In addition, monotherapy is de-emphasized in favor of combination therapy. On the other hand, many authorities, including various expert panels, have not recommended initiating antihypertensive therapy at lower blood pressure goals in black patents than in other patient groups (table 2)[4-6].
The majority of the black-white disparity in hypertension control is accounted for by lower control rates in black men as compared with white men (table 3). In addition to needing more widespread and effective therapy of blacks with hypertension, novel methods to enhance screening and patient education, such as that illustrated by the barber-based interventional trial , may increase hypertension control in black men and improve racial equity in hypertension control.
CHOICE OF ANTIHYPERTENSIVE DRUGS
The optimal choice of drug or combination of drugs in black patients principally depends upon the presence or absence of comorbid conditions and the specific efficacy of the agent(s) to attain goal blood pressure . Overall, the choice of antihypertensive drugs in black patients is similar to that in older adults.
Overview — Recommendations about the choice of antihypertensive therapy are presented elsewhere. Briefly:
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