[Hypertension in the Negro patient]

Area of Science:

• Cardiology
• Nephrology
• Genetics

Background:

• Essential hypertension is more prevalent in Black populations, with earlier onset and more severe complications like heart, kidney, and cerebrovascular diseases.
• Differences in hypertension prevalence and complications between Black and White individuals may stem from genetic and environmental factors.

Purpose of the Study:

• To explore the unique characteristics of hypertension in Black individuals.
• To discuss potential contributing factors, including genetic, environmental, and socioeconomic variables.
• To recommend tailored antihypertensive therapeutic strategies for Black patients.

Main Methods:

• Review of existing data and studies focusing on hypertension in the African-American population.
• Analysis of physiological characteristics such as salt sensitivity, plasma volume, and renin levels.
• Evaluation of treatment responses to various antihypertensive medications.

Main Results:

• Hypertension in Black individuals is associated with salt sensitivity, expanded plasma volume, and low plasma renin.
• Obesity, insulin resistance, and socioeconomic factors may contribute to higher hypertension prevalence.
• Black patients often show reduced responsiveness to monotherapy with ACE inhibitors and beta-blockers, but this can be overcome with diuretics.

Conclusions:

• Aggressive antihypertensive therapy, potentially with lower blood pressure goals, is crucial for Black patients.
• Diuretic monotherapy is recommended as first-line treatment, with calcium channel blockers as alternatives.
• Combination therapy, particularly including a diuretic, can improve treatment response in Black patients often less responsive to other agents.