What is the treatment for hypertension in a 78-year-old African-American patient?

From the Guidelines

For a 78-year-old African-American patient with hypertension, I recommend starting with a thiazide diuretic such as chlorthalidone 12.5-25mg daily or hydrochlorothiazide 12.5-25mg daily, possibly combined with a calcium channel blocker like amlodipine 5-10mg daily, as this combination is particularly effective in African-American patients 1.

When managing hypertension in this patient population, it's essential to consider the most recent and highest quality evidence. The 2020 International Society of Hypertension Global Hypertension Practice Guidelines 1 provide a comprehensive approach to treating hypertension, including specific recommendations for African-American patients.

Key considerations in treating hypertension in African-American patients include:

• Starting with a low dose of a thiazide diuretic or a dihydropyridine calcium channel blocker (DHP-CCB)
• Possibly combining a DHP-CCB with a thiazide diuretic for enhanced efficacy
• Considering the addition of an angiotensin receptor blocker (ARB) or an angiotensin-converting enzyme inhibitor (ACEI) if necessary
• Regular monitoring and follow-up to assess efficacy and potential side effects

Lifestyle modifications are also crucial in managing hypertension:

• Reducing sodium intake to less than 2.3g daily
• Maintaining regular physical activity, such as 30 minutes of moderate activity most days
• Limiting alcohol consumption
• Following a DASH diet rich in fruits, vegetables, and low-fat dairy

The goal blood pressure for this patient should be around 130-139/70-79 mmHg, balancing cardiovascular protection with the risks of excessive blood pressure lowering in older adults 1. Regular monitoring is crucial, with follow-up within 2-4 weeks of starting treatment to assess efficacy and potential side effects.

In terms of specific medication choices, the guidelines suggest that African-American patients often respond better to calcium channel blockers and diuretics than to ACE inhibitors or ARBs when used as monotherapy 1. However, the most recent guidelines from 2020 1 provide a more comprehensive approach to treating hypertension in this patient population.

Overall, the treatment of hypertension in a 78-year-old African-American patient should prioritize a combination of lifestyle modifications and pharmacological interventions, with a focus on using the most effective and well-tolerated medications, such as thiazide diuretics and calcium channel blockers.

From the FDA Drug Label

Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy. Amlodipine besylate tablets may be used alone or in combination with other antihypertensive agents. Lisinopril tablets USP may be administered alone or with other antihypertensive agents

The treatment for hypertension in a 78-year-old African-American patient may involve amlodipine or lisinopril, which can be used alone or in combination with other antihypertensive agents. However, it is essential to consider that some antihypertensive drugs have smaller blood pressure effects in black patients, which may guide the selection of therapy 2 3.

• Key considerations for treatment include:
  • Using amlodipine or lisinopril as monotherapy or in combination with other agents
  • Considering the patient's age, ethnicity, and potential comorbidities when selecting therapy
  • Monitoring blood pressure and adjusting treatment as needed to achieve optimal blood pressure goals.

From the Research

Treatment Approach

The treatment for hypertension in a 78-year-old African-American patient involves a comprehensive approach that includes:

• Multifactorial lifestyle modifications such as weight loss, salt and alcohol restriction, and increased physical activity 4
• Drug therapy, with the majority of patients requiring combination antihypertensive drug therapy to maintain blood pressure consistently below target levels 4, 5
• Risk stratification to determine goal blood pressure levels and to identify patients who require combination drug therapy 4

Lifestyle Modifications

Lifestyle modifications are an essential part of the treatment approach and include:

• Weight loss 5, 6, 7
• Decreased sodium ingestion 5, 6, 7
• Increased potassium intake 5
• Exercise 5, 7
• Increased consumption of dairy products, fruit, and vegetables 6

Drug Therapy

Drug therapy for hypertension in African-American patients may involve:

• Combination antihypertensive agents, such as beta-adrenoceptor antagonist/diuretic, ACE inhibitor/diuretic, ACE inhibitor/calcium channel antagonist, and angiotensin receptor antagonist/diuretic 5
• Calcium channel blocker therapy, which is often used in combination with other agents 6
• Diuretics, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers, which are commonly used in the treatment of hypertension in African-American patients 4, 6, 8

Combination Therapy

Combination therapy is often required to achieve blood pressure control in African-American patients, particularly those with blood pressure >15/10 mmHg above goal levels 4, 5. The preferred combination is a calcium antagonist/angiotensin-converting enzyme inhibitor or, alternatively, a thiazide diuretic/angiotensin-converting inhibitor 4.