Hypertension in diverse populations: a New York State Medicaid clinical guidance document

The New York State Medicaid Prescriber Education Program (PEP) is a partnership between the Department of Health and state academic institutions that provides prescribers with an evidence-based, noncommercial source of the latest objective information about pharmaceuticals. This article, detailing treatment of uncomplicated hypertension in diverse populations, represents one of the first large-scale PEP initiatives. The main risk factors for hypertension are age and obesity. Disparities in hypertension risk and outcomes among diverse populations are now believed to be more a function of personal habits, socioeconomic status and psychosocial factors rather than race, ethnicity, or genetics. Blood pressure is controllable in most patients, and all patients should be treated according to best practices. Lifestyle modification, especially diet and exercise, should be encouraged, but most patients will require more than one antihypertensive medication to control blood pressure. Combination therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker plus thiazide-type diuretic or dihydropyridine calcium channel blocker is largely universal in efficacy. Improved provider-patient partnership and communication is important to blood pressure lowering success, and cultural sensitivity should be taken into account where applicable.