From the Guidelines
Calcium channel blockers (CCBs) are often prescribed as first-line treatment for hypertension in Black people because they are particularly effective in this population. Black individuals typically have lower renin levels and are more likely to have salt-sensitive hypertension, making them more responsive to CCBs and diuretics than to other antihypertensive medications like ACE inhibitors or ARBs when used as monotherapy 1, 2, 3. Common CCBs prescribed include amlodipine (5-10 mg daily), nifedipine extended-release (30-90 mg daily), and diltiazem extended-release (120-540 mg daily). These medications work by blocking calcium entry into vascular smooth muscle cells, causing vasodilation and reducing peripheral resistance, which effectively lowers blood pressure. CCBs are also beneficial because they have fewer metabolic side effects compared to some other antihypertensives, making them suitable for patients with diabetes or metabolic syndrome. Additionally, they demonstrate good efficacy regardless of age or salt intake. Common side effects include peripheral edema, headache, and constipation (particularly with non-dihydropyridine CCBs like diltiazem). For optimal blood pressure control in Black patients, CCBs are often combined with thiazide diuretics if monotherapy is insufficient.
Some key points to consider when prescribing CCBs for hypertension in Black patients include:
- The American College of Cardiology/American Heart Association (ACC/AHA) recommends initial antihypertensive drug therapy in Black patients to include a thiazide-type diuretic or CCB 2, 3.
- The European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline also recommends initial treatment in most Black patients to be with a 2-drug combination, comprising a diuretic and CCB, either in combination with each other or with an ACE inhibitor or ARB 3.
- Single-pill combinations can improve treatment adherence, but may contain lower-than-optimal doses of the thiazide diuretic component 3.
- CCBs have been shown to be effective in reducing cardiovascular risk in Black patients with hypertension, particularly when used in combination with other antihypertensive agents 1, 2, 3.
Overall, the use of CCBs as first-line treatment for hypertension in Black patients is supported by the latest evidence and guidelines, and can be an effective strategy for reducing blood pressure and cardiovascular risk in this population.
From the Research
Calcium Channel Blockers in Black People
- Calcium channel blockers (CCBs) are often prescribed as a first-line treatment for hypertension in black people due to their efficacy in reducing blood pressure in this population 4, 5.
- Studies have shown that black patients may have a reduced blood pressure response to angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) compared to white patients, making CCBs a more effective treatment option 4.
- The Eighth Joint National Committee (JNC-8) published hypertension guidelines that varied depending on patient race, with CCBs being a recommended treatment option for black patients 6.
Rationale for CCBs in Black People
- CCBs are effective in reducing cardiovascular morbidity and mortality associated with uncontrolled hypertension, including stroke 7.
- They are suitable for add-on therapy in combination with other agents, such as diuretics, ACE inhibitors, and angiotensin-II receptor blockers 7.
- CCBs may be particularly beneficial for black patients with comorbid conditions, such as isolated systolic hypertension or angina pectoris 7.
Prescribing Patterns and Outcomes
- National guidelines recommend different pharmacologic management of hypertension for black Americans compared to non-black Americans, with CCBs being a preferred treatment option 8.
- Studies have shown that black Americans are more likely to be prescribed CCBs as monotherapy, and that CCBs are effective in reducing blood pressure in this population 8.
- However, despite the use of CCBs, hypertension control remains worse in black Americans compared to non-black Americans, highlighting the need for individualized treatment approaches 8.