Drug treatment considerations for the hypertensive black patient

In prior years the major differences noted between hypertension in black and white patients have been mostly epidemiological, with some suggestion that the differences were primarily quantitative and probably not qualitative. Recently, certain pathophysiological aberrations in hypertensive patients have been shown to be different in blacks and whites. Whether these differences are primary (genetic) or secondary has yet to be resolved. Nevertheless, certain racial differences may have therapeutic implications. Diuretics remain the mainstay of therapy for most hypertensive black patients. beta-Blockers and angiotensin-converting enzyme (ACE) inhibitors have not shown great efficacy when used as monotherapy in black hypertensive patients. The combination of a diuretic with beta-blockers or ACE inhibitors, however, has been shown to abolish black-white differences in drug response. More recently, the calcium channel blockers have been shown to be potentially effective in black hypertensive patients. In spite of the effective drug therapy that is available for hypertensive patients in general, economic and social considerations continue to contribute to the low rate of detection, treatment, and control of hypertension in the black population.