Race-based Therapy for Hypertension: Possible Benefits and Potential Pitfalls

Keith C. Ferdinand; Daphne P. Ferdinand

Disclosures

Expert Rev Cardiovasc Ther. 2008;10(6):1357-1366. 

In This Article

Abstract and Introduction

Abstract

Hypertension is a leading risk factor for cardiovascular disease, which includes coronary heart disease, heart failure and stroke. This article examines the possible benefits and potential pitfalls of utilizing race-based categories for antihypertensive therapy. Although the use of race and ethnicity to guide antihypertensive treatment is fraught with difficulty and is, to a large extent, inadequate, there may be benefit in recognizing specific aspects of race and ethnicity when approaching patients with hypertension. Evidence from clinical trials, including drug efficacy and safety comparisons and cardiovascular outcomes, has demonstrated some differences based on race/ethnicity. American federal standards strongly encourage capturing data on race/ethnicity, and most of the current data are available for self-described African-Americans. International studies increasingly identify race/ethnicity, although the data are not as robust as in US trials. Current guidelines recommend thiazide diuretics and/or long-acting calcium channel blockers as initial treatment for Blacks, although medications for compelling indications agents should be prescribed, regardless of race/ethnicity.

Introduction

Hypertension is a major risk factor for cardiovascular disease (CVD), the leading cause of death for all industrialized societies, which includes coronary heart disease (CHD), heart failure (HF) and stroke. Race is not a scientific category, but a demographic term used by social scientists, historians, politicians and others. However, there are some nuances in antihypertensive medication response, complications and even outcomes, based on self-defined race/ethnicity. In the USA, an increasingly heterogeneous society, the mandated use of race/ethnicity in CVD research has led to provocative data, impacting clinical guidelines and antihypertensive therapy. In general, specific mechanisms and explanations as to why differences in therapy response and complications exist are unclear, if not impossible to conclusively identify. This article is conceived as a reflection of present efficacy and safety studies, in addition to randomized clinical trial evidence for potential differences in hypertension in racial/ethnic groups. Additional observations will be noted regarding pathophysiology and epidemiology.

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