Hypertension in Afro-Americans
- Afro-Americans have the highest prevalence (44% men and women) of hypertension compared to 34% white men and 30% white women.1
- Hypertension is not only more common but also more dangerous in blacks. The death rates from hypertension per 100,000 population were15 in white men and women whereas the rates were 51 in black men and 41 in black women (in 2005).2
- The incidence of hypertension is also high among blacks. In the CARDIA (community-based Coronary Artery Risk Development in Young Adults) Study, the 20 year cumulative incidence was 35% in black men and 38% in black women compared to 21% in white men and 12% in white women (when the mean age was 45).3
- The updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks recommends initiating comprehensive lifestyle modifications when blood pressure is 115/75 mm Hg─ the threshold at which cardiovascular (CVD) risk begins.2
- In primary prevention, (elevated blood pressure without target organ damage, preclinical or overt CVD) the blood pressure target is <135/85 mm Hg. In secondary prevention, (elevated blood pressure with target organ damage, preclinical or clinical CVD) the blood pressure target is <130/80 mm Hg.2
- The guidelines also emphasize effective multidrug regimens, and de-emphasize monotherapy. If blood pressure is 10 mm Hg above target levels, monotherapy with a diuretic or calcium channel blocker is preferred. When blood pressure is >15/10 mm Hg above target, 2-drug therapy is recommended, with either a calcium channel blocker plus a renin-angiotensin system blocker (in contrast to 20 mm Hg increase in systolic blood pressure in whites).
- Alternatively, in volume-overload states, a thiazide diuretic plus a renin-angiotensin system blocker is recommended. Many patients may need four or more medications to get the blood pressure target (resistant hypertension).
1. American Heart Association Heart and Stroke Statistical Update2010.
2. Flack JM, Sica DA, Bakris G, et al. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. Nov 2010;56(5):780-800.
3. Levine DA, Lewis CE, Williams OD, et al. Geographic and demographic variability in 20-year hypertension incidence: the CARDIA study. Hypertension. Jan 2011;57(1):39-47.