What are the recommended blood pressure (BP) medications for African Americans with hypertension?

From the Guidelines

African Americans with hypertension should be treated with thiazide diuretics or calcium-channel blockers as first-line therapy, as these medications have been shown to be more effective in lowering blood pressure and reducing cardiovascular disease events in this population. This recommendation is based on the most recent and highest quality study, which suggests that thiazide diuretics and calcium-channel blockers are the preferred options for first-line therapy in African Americans with hypertension, including those with diabetes mellitus 1.

The evidence suggests that African Americans have a higher prevalence of hypertension and are more likely to experience cardiovascular disease events, such as stroke, heart failure, and end-stage renal disease, compared to other racial and ethnic groups 1. Therefore, it is essential to prioritize the use of medications that have been shown to be effective in reducing blood pressure and cardiovascular disease risk in this population.

Some key points to consider when treating African Americans with hypertension include:

• Thiazide diuretics, such as chlorthalidone, are a good option for first-line therapy, as they have been shown to be effective in lowering blood pressure and reducing cardiovascular disease events 1.
• Calcium-channel blockers, such as amlodipine, are also a good option for first-line therapy, as they have been shown to be effective in lowering blood pressure and reducing cardiovascular disease events 1.
• Combination therapy may be necessary to achieve target blood pressure goals, and a common effective combination is a calcium channel blocker plus a thiazide diuretic 1.
• Lifestyle modifications, including reduced sodium intake, regular exercise, and maintaining a healthy weight, remain important complementary approaches to medication therapy 1.

Overall, the goal of treatment should be to reduce blood pressure to a target level of less than 130/80 mmHg, and to minimize the risk of cardiovascular disease events. By prioritizing the use of thiazide diuretics and calcium-channel blockers as first-line therapy, and by incorporating lifestyle modifications and combination therapy as needed, healthcare providers can help to improve outcomes for African Americans with hypertension.

From the Research

BP Medication for African Americans

• The treatment of hypertension in African Americans requires a comprehensive approach that includes lifestyle modifications and drug therapy 2.
• The preferred combination of drugs for African American patients with hypertension is a calcium antagonist/angiotensin-converting enzyme inhibitor or a thiazide diuretic/angiotensin-converting inhibitor 2.
• Combination antihypertensive drug therapy is often necessary to maintain blood pressure consistently below target levels in African American patients 2, 3, 4.
• The choice of drugs for combination therapy in African American patients may be different, with diuretics and calcium channel blockers being more effective than ACE inhibitors, angiotensin receptor blockers, and beta blockers as monotherapy 4.
• First-line combination therapy is recommended for African American patients with systolic BP >15 mm Hg or a diastolic BP >10 mm Hg above goal 3, 4.
• The Eighth Joint National Committee (JNC-8) published hypertension guidelines that varied depending on patient race, with different treatment recommendations for Black and non-Black patients 5.
• The guidelines recommend initial therapy with thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs) for non-Black patients, but remove ACE inhibitors and ARBs from the algorithm for Black patients 5.

Key Considerations

• African Americans have a higher prevalence of hypertension and experience worse disease severity compared to other racial/ethnic groups 6, 4.
• The high prevalence of type 2 diabetes mellitus in African Americans compounds the excessive burden of cardiovascular and kidney disease 3.
• Lifestyle modifications, such as weight loss, decreased sodium ingestion, increased potassium intake, exercise, and weight loss, are essential for achieving better blood pressure control in African American patients 2, 3.