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Published on: May 17, 2024
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Treating hypertension in Black patients
1Nathan J. Gardner is program director and an assistant professor in the PA program at Albany (N.Y.) Medical College. The author has disclosed no potential conflicts of interest, financial or otherwise.
Summary
The JNC-8 hypertension guidelines introduced race-based treatment recommendations, excluding ACE inhibitors and ARBs for Black patients. This review explores the physiological basis and potential complications of these race-based hypertension treatment algorithms.
Area of Science:
- Cardiology
- Pharmacology
- Health Disparities
Background:
- The Eighth Joint National Committee (JNC-8) guidelines marked a significant shift by incorporating race into hypertension treatment recommendations.
- Previous guidelines did not differentiate initial antihypertensive therapy based on patient race.
Purpose of the Study:
- To review the physiological theories behind race-based hypertension treatment recommendations.
- To discuss potential complications arising from race-based treatment algorithms in hypertension management.
Main Methods:
- Literature review of physiological theories.
- Analysis of JNC-8 guideline differences.
- Discussion of clinical implications.
Main Results:
- JNC-8 guidelines recommend different initial therapy for Black and non-Black patients with hypertension.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) were excluded from initial treatment recommendations for Black patients.
- Non-Black patients have a broader choice of initial antihypertensive agents.
Conclusions:
- Race-based hypertension treatment algorithms raise questions about underlying physiological differences.
- Potential complications and the scientific basis of these race-based recommendations require further investigation.
- The implications of race as a factor in hypertension management strategies warrant critical evaluation.
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