What is the most effective antihypertensive (high blood pressure) medication for African Americans?

From the Guidelines

For Black individuals with hypertension, thiazide diuretics or calcium channel blockers (CCBs) are the most effective first-line treatments, as they have been shown to be more effective in lowering blood pressure and reducing cardiovascular disease events in this population. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, thiazide diuretics and CCBs are recommended as initial antihypertensive treatment in Black adults with hypertension but without heart failure or chronic kidney disease, including those with diabetes.

Some key points to consider when treating hypertension in Black individuals include:

• Thiazide diuretics, such as hydrochlorothiazide or chlorthalidone, are effective options, with dosages ranging from 12.5-25mg daily 1.
• Calcium channel blockers, such as amlodipine, are also effective, with dosages ranging from 5-10mg daily 1.
• ACE inhibitors and angiotensin receptor blockers (ARBs) are generally less effective when used alone in Black patients, unless there is a compelling indication like diabetes or kidney disease 1.
• Combination therapy may be necessary if a single medication does not achieve target blood pressure, with a calcium channel blocker plus a thiazide diuretic being a particularly effective combination 1.
• Regular monitoring of blood pressure and kidney function is important when starting or adjusting these medications, especially with diuretics which can affect electrolyte levels 1.

It's worth noting that the evidence from the 2019 KDOQI US commentary on the 2017 ACC/AHA hypertension guideline 1 and the 2018 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1 supports the use of thiazide diuretics or CCBs as first-line treatments for Black individuals with hypertension. Overall, the choice of antihypertensive medication should be individualized based on the patient's specific needs and medical history.

From the FDA Drug Label

ACE inhibitors, including lisinopril, have an effect on blood pressure that is less in black patients than in non-blacks. Losartan was effective in reducing blood pressure regardless of race, although the effect was somewhat less in Black patients (usually a low-renin population)

The most effective antihypertensive medication for African Americans is not explicitly stated in the provided drug labels. However, based on the available information:

• Lisinopril has an effect on blood pressure that is less in black patients than in non-blacks 2.
• Losartan was effective in reducing blood pressure regardless of race, although the effect was somewhat less in Black patients 3. It is essential to consider individual patient characteristics and responses to medication when selecting an antihypertensive treatment.

From the Research

Antihypertensive Medications for African Americans

The most effective antihypertensive medication for African Americans can be determined by considering various studies that have investigated the efficacy of different drug classes in this population.

• Thiazide diuretics are often recommended as the initial treatment for hypertension in African Americans, as they have been shown to be effective in reducing blood pressure and cardiovascular risk in this population 4, 5, 6.
• Calcium channel blockers (CCBs) have also been found to be effective in African Americans, with some studies suggesting that they may be more effective than thiazide diuretics in certain cases 7, 8.
• Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may not be as effective as thiazide diuretics or CCBs in African Americans, although they can still be used in combination with other medications to achieve blood pressure control 4, 6.
• Combination therapy, such as amlodipine/valsartan, may be more effective than monotherapy in achieving blood pressure control in African Americans with stage 2 hypertension 8.

Key Findings

• A study published in the Journal of the National Medical Association found that thiazide diuretics were the most effective antihypertensive medication in African Americans, with a significant reduction in blood pressure and cardiovascular risk 5.
• A study published in the Archives of Internal Medicine found that CCBs were more effective than thiazide diuretics in reducing blood pressure in African Americans, although this finding was not consistent across all studies 7.
• A study published in the Journal of Human Hypertension found that combination therapy with amlodipine/valsartan was more effective than monotherapy with amlodipine in achieving blood pressure control in African Americans with stage 2 hypertension 8.

Considerations for Treatment

• The choice of antihypertensive medication for African Americans should be based on individual patient characteristics, such as the presence of comorbidities and the severity of hypertension.
• Combination therapy may be necessary to achieve blood pressure control in some patients, and the choice of medications should be based on the patient's response to treatment and the presence of any side effects.
• Lifestyle modifications, such as diet and exercise, should also be encouraged in conjunction with medication therapy to achieve optimal blood pressure control 4.