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

Authors and Disclosures

Keith C. Ferdinand, Clinical Professor, Division of Cardiology, Emory University; and, Chief Science Officer, Association of Black Cardiologists, 5355 Hunter Road, Atlanta, GA 30080, USA.

Daphne P. Ferdinand, Assistant Professor, Adjunct Faculty, Louisiana State University Health Sciences Center, School of Public Health, LA, USA.

E-Mail: Keith C. Ferdinand - kferdinand@abcardio.org ; Daphne P. Ferdinand - daferd@aol.com

Disclosure: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Sidebar: Key Issues

• The concept of race is without specific genetic markers and is actually a sociodemographic term rather than a scientific category. Ancestry determination is more accurate.

• Hypertension is a leading risk factor for cardiovascular disease but varies by race/ethnicity, specifically in the USA.

• Hypertension in African-Americans tends to be more severe and more prevalent, with increased target organ damage.

• Clinical trials have indicated less antihypertensive response to monotherapy with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and β-blockers in US Black patients. However, the addition of a thiazide diuretic or, alternatively, long-acting calcium channel blockers blunts much of the differences in blood-pressure response in Blacks compared with Whites.

• Complications of therapy, such as cough and angioedema with angiotensin-converting enzyme inhibitors, may vary across populations, with possibly increased side effects seen in African-Americans and Asians.

• Despite potential differences in response to drug monotherapy, most patients will need two or even three drugs to control blood pressure to adequate levels.

• The presence of compelling indications should be of prime importance, along with blood pressure control, in the selection of specific antihypertensive agents regardless of race or ethnicity.