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Treatment of hypertension in blacks

Brent M Egan, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc


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) [1]. As a result, effective antihypertensive therapy is particularly important in these patients [2]. (See "Hypertensive complications in blacks".)

According to the 2010 recommendations from the International Society on Hypertension in Blacks [3], 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]. Goal blood pressure in treated hypertensive black patients is discussed elsewhere. (See "What is goal blood pressure in the treatment of hypertension?".)

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 [7], may increase hypertension control in black men and improve racial equity in hypertension control.


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 [8]. Overall, the initial 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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Literature review current through: Nov 2017. | This topic last updated: Jan 30, 2017.
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