Chapter 11 Hypertension- African-Americans have a high prevalence of type 2 diabetes mellitus. Based on current National Cholesterol Education
Program guidelines, patients with type 2 diabetes have a CHD risk that is equivalent to patients with CHD and require intensive
interventions to lower LDL cholesterol levels to <100 mg/dL (<2.59 mmol/L) - The perception that it is more medically diffi cult to lower BP in African-Americans than in other patients is unjustifi ed.
- All antihypertensive drug classes are associated with BP-lowering effi cacy in African-Americans, although combination
therapy may frequently be required to achieve and maintain target BP. - As monotherapy, β-blockers and angiotensin-converting enzyme inhibitors may produce less BP-lowering effects in
African-Americans. - Thiazide diuretics and calcium channel blockers may have greater BP-lowering effi cacy than do other classes in
African-Americans. - Where compelling indications have been identifi ed for prescribing specifi c classes of agents, such as β-blockers or
renin–angiotensin system blocking agents (ACE inhibitors or angiotensin II receptor blockers), these compelling indications
should be applied equally to African-American patients. - When prescribing ACE inhibitors, it is important to note that compared with whites, African-Americans appear to be at
increased risk for ACE inhibitor-associated angioedema, cough, or both. All patients should be instructed to report any
symptoms related to angioedema promptly.
Reproduced, with permission, from Reference [8].African-Americans [8]
In 2003, the Consensus Statement of the Hyperten-
sion in African-Americans Working Group of the
International Society of Hypertension in Blacks
“Management of High Blood Pressure in African-
Americans” was published [8]. Box 11.2 is a distil-
lation of the main clinical points.
Future directions
The next important advance will be the generation of
the NHLBI-sponsored JNC 8, the eighth report of the
Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure,
which is still in the earliest stage of its gestation. It is
clear that there is a good, evidence-based, trend toward
more aggressive treatment of BP to lower goals than
ever before, and this will doubtless be incorporated
into the JNC 8 recommendations. Another area that is
rapidly evolving is the pharmacotherapy of hyperten-
sion, with the recent development of new drugs, such
as renin inhibitors and vasodilating β-blockers, all of
which will need outcomes studies to underpin their
utility in the treatment of hypertension. It is highly
likely, also, that the new science of pharmacogenomics
will aid us in tailoring appropriate therapy to each
patient. However, the greatest benefi t to the greatest
number of people will be achieved by low-technology
strategies to ensure that existing treatments are applied
to the 80% or so of our population who are hyperten-
sive and are inadequately treated or not treated at all.Acknowledgements
I am grateful to Dr Lawrence J. Appel, Professor of
Medicine at The Johns Hopkins University, and
Chair of the AHA Scientifi c Statement Writing
Committee on “Dietary Approaches to Prevent and
Treat Hypertension” for drafting the paragraphs on
“Lifestyle Modifi cations.”References available online at http://www.Wiley.com/go/
AHAGuidelineHandbook.During the production of this book these relevant
AHA statements and guidelines were published:
Ambulatory Blood Pressure Monitoring in Children
and Adolescents, http://hyper.ahajournals.org/cgi/
reprint/HYPERTENSIONAHA.108.190329; Call to
Action on Use and Reimbursement for Home Blood
Pressure Monitoring, http://hyper.ahajournals.org/
cgi/content/full/52/1/10; Resistant Hypertension:
Diagnosis, Evaluation, and Treatment, http://
hyper.ahajournals.org/cgi/content/full/51/6/1403;
Population-Based Prevention of Obesity, http://
circ.ahajournals.org/cgi/content/full/118/4/428.