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Hypertension in minorities: blacks
1Division of Hypertension, University of Maryland School of Medicine, Baltimore, 21201, USA.
Insights
Black individuals experience hypertension more frequently, with severe cases leading to greater organ damage and mortality. Tailored treatment strategies, considering cost-effective options, can improve outcomes and reduce complications in this population.
Area of Science:
- Cardiology
- Nephrology
- Neurology
Background:
- Hypertension is significantly more prevalent in Black individuals compared to the general population.
- Severe hypertension occurs 3-7 times more frequently in Black individuals, leading to excessive target organ damage (heart, kidneys, brain) and higher mortality.
- Unique clinical presentations, healthcare access delays, and pathophysiological factors necessitate tailored hypertension management for Black patients.
Purpose of the Study:
- To review the challenges and effective treatment strategies for hypertension in the Black population.
- To highlight the importance of considering specific pathophysiological features and socioeconomic factors in treatment decisions.
- To emphasize that effective management can improve survival and reduce morbidity.
Main Methods:
- Review of existing literature on hypertension in the Black population.
- Analysis of treatment guidelines (e.g., JNC-V) and drug efficacy.
- Consideration of socioeconomic factors influencing treatment choices.
Main Results:
- Diuretics and beta-blockers are cost-effective first-line options.
- Calcium channel blockers are effective, comparable to their efficacy in White populations.
- Angiotensin-converting enzyme inhibitors, particularly with low-dose diuretics, show significant effectiveness.
Conclusions:
- Tailored hypertension management is crucial for the Black population due to higher prevalence and risk of complications.
- Cost-effective medications should be prioritized, but other effective drug classes are available.
- Effective treatment strategies can lead to improved survival rates and reduced mortality and morbidity.
Abstract:
Hypertension is known to occur much more frequently in blacks than in the general population, roughly 33% to 50% more frequently. In addition, severe hypertension occurs 3 to 7 times more commonly in blacks than whites and is associated with an excessive amount of target organ damage. Thus, damage to the heart, kidneys, and cerebral structures may occur as much as three to five times more frequently in blacks than the general population and is associated with a much greater mortality. Because of differences in clinical presentation, delays in entering the medical care system, and some pathophysiologic features specific for the black population, treatment becomes somewhat more challenging and should be tailored for this population. Because of economic factors often found in minority populations, inexpensive effective drugs such as diuretics and beta-blockers, which are preferred drugs according to the JNC-V, often should be given first consideration in this population. However, calcium channel blockers seem to be quite effective in this group, equal to in the white population, although they are somewhat more expensive. Angiotensin converting enzyme inhibitors, if given in proper dosage and especially with low dose diuretics, are also quite effective in this population. Tissue specific angiotensin converting enzyme inhibitors may be more effective, but further studies are needed. Studies have shown that effective treatment of the black population, in spite of the differences and the more challenging situation, can result in improved survival and reduction in morbidity and mortality from the various complications.