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Beyond controlling blood pressure in the black patient: metabolic considerations
1Georgetown University Medical Center, Washington, DC 20007, USA.
Insights
African Americans face high hypertension rates and complications. New therapies avoiding adverse metabolic effects may improve cardiac outcomes beyond traditional treatments.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Pharmacology
Background:
- Hypertension is notably prevalent in African Americans, with increased susceptibility to end-organ damage.
- Established diuretic-based therapies effectively mitigate hypertension-related stroke, heart failure, and mortality, but coronary death prevention remains suboptimal.
- Adverse metabolic effects associated with certain diuretics and beta-blockers may contribute to less favorable cardiac outcomes.
Purpose of the Study:
- To explore antihypertensive agents with favorable metabolic profiles for improved cardiac outcomes.
- To maintain the established benefits of current hypertension therapies while enhancing cardiovascular protection.
Main Methods:
- Review of existing literature on hypertension treatment in African Americans.
- Analysis of the metabolic effects of various antihypertensive drug classes.
- Evaluation of evidence linking specific drug classes to cardiac outcomes.
Main Results:
- Traditional therapies show success in reducing major complications but are less effective for coronary events.
- Certain antihypertensive drugs possess adverse metabolic profiles that could impact cardiac health.
- Agents without these metabolic drawbacks offer potential for better cardiovascular protection.
Conclusions:
- Optimizing hypertension treatment for African Americans requires considering agents that balance blood pressure control with metabolic neutrality.
- Improving cardiac outcomes is a key objective in contemporary hypertension research and clinical practice.
- Further research into metabolically benign antihypertensives is warranted to enhance patient cardiovascular health.
Abstract:
Hypertension is highly prevalent among African Americans, who are also more likely than whites to develop end-organ complications of hypertension. Traditional diuretic-based stepcare therapy has successfully reduced such complications of hypertension as stroke, congestive heart failure, and premature death in all populations tested. Prevention of coronary deaths has been less successful. Potentially adverse metabolic effects of thiazide diuretics and some beta-blockers may partially explain the less successful cardiac outcomes. Use of antihypertensive agents lacking adverse metabolic effects but still achieving effective blood pressure control could improve cardiac outcomes while maintaining the benefits achieved with older forms of therapy. Achievement of improved cardiac outcomes is now one of the principal goals of hypertension research and treatment.