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

Conclusion

The JNC7 suggests that, in treating special populations, generally the approach is similar to that for all demographic groups.[10] Social, economic and lifestyle factors, along with clinical treatment inertia are extremely important to identify as barriers to BP control.[66,67,68,69] The prevalence and severity of hypertension in Blacks is clearly higher. Furthermore, there may be reduced response to monotherapy with β-blockers, ACEIs or ARBs versus diuretics or CCBs in Blacks. Nevertheless, adding adequate doses of a diuretic usually eliminates or blunts these differences. For all racial/ethnic populations with compelling indications, such as HF or postmyocardial infarction, RAAS-blocking agents including ACEIs, ARBs and β-blockers should be a component of the antihypertensive regimen. For Hispanic and Asian-Americans, antihypertensive therapy should be similar to that for the general population. Comorbidity with obesity, metabolic syndrome and diabetes is especially problematic in these populations.

Regardless of race or ethnicity, most patients who have complicated hypertension or higher stages of hypertension will not achieve BP control with monotherapy.[10] Two or more medications are usually needed to achieve BP goals, especially when the BP is more than 20/10 mmHg above an individual's goal; and clinicians should consider initiating therapy with two drugs.[11] Thiazide-type diuretics should be first-line therapy for most patients with hypertension, regardless of race or ethnicity, either alone or combined with drugs from other classes. Combination therapy, especially in high-risk patients that have complicated hypertension or higher grades of BP, may increase the likelihood of a successful achievement of BP goals.

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