Race and hypertension. What is clinically relevant?

Area of Science:

• Cardiology
• Nephrology
• Public Health

Background:

• Hypertension is disproportionately prevalent in Black populations globally, particularly in the US.
• Pathophysiological factors like salt sensitivity and volume expansion are more common in Black patients.
• Insulin resistance is also reported in African Americans, potentially linking to hypertension risk and treatment.

Purpose of the Study:

• To explore the unique pathophysiological mechanisms of hypertension in Black populations.
• To evaluate the effectiveness of current antihypertensive therapies, especially diuretic-based regimens, for kidney protection.
• To identify areas for future research regarding risk identification and optimal treatment strategies.

Main Methods:

• Review of existing literature on hypertension prevalence, pathophysiology, and treatment outcomes in Black individuals.
• Analysis of studies examining the relationship between plasma renin activity, plasma volume, and blood pressure.
• Examination of data on hypertensive kidney disease and the impact of different therapeutic approaches.

Main Results:

• Black patients frequently present with volume expansion, and salt sensitivity appears common.
• No significant relationship was found between plasma renin activity, plasma volume, and blood pressure in Black patients.
• Diuretic-based therapies have not demonstrated efficacy in delaying or preventing kidney function loss in hypertensive kidney disease.

Conclusions:

• Lifestyle modifications are the initial therapeutic approach for hypertension.
• While diuretics and beta-blockers reduce cardiovascular risk, their role in delaying kidney disease progression in Black patients is debated.
• Further research is needed to establish long-term cardiovascular benefits of alternative antihypertensive agents in Black hypertensive patients.