What is the best medication for hypertension in a man of Nigerian origin?

Best Antihypertensive Medication for Men of Nigerian Origin

For men of Nigerian origin with hypertension, a calcium channel blocker (CCB) such as amlodipine should be the first-line medication due to its superior efficacy in this population. 1

Rationale for CCB as First-Line Therapy

Black patients, including those of Nigerian descent, respond better to CCBs and thiazide-type diuretics than to ACE inhibitors or ARBs as monotherapy 1. This is due to physiological differences including:

• Suppressed renin-angiotensin-aldosterone system (RAAS) in people of African descent 2
• Greater salt sensitivity compared to other ethnic groups 1
• Higher prevalence of resistant and nighttime hypertension 2

Specific Medication Recommendations

First-Line Option:

• Amlodipine (5-10 mg once daily): FDA-approved for hypertension with proven efficacy in lowering blood pressure and reducing cardiovascular events 3, 4
  • Long half-life (35-50 hours) providing 24-hour coverage
  • Sustained antihypertensive effect even if a dose is missed
  • Reduces BP variability effectively 4

Alternative First-Line Option:

• Thiazide or thiazide-like diuretics (e.g., chlorthalidone 12.5-25 mg daily) 2, 1
  • Particularly effective in black patients
  • Consider monitoring electrolytes, uric acid, and renal function

Combination Therapy Approach

If blood pressure remains uncontrolled on monotherapy:

1. Initial combination: CCB + ARB or CCB + thiazide diuretic 1

   • Consider single-pill combinations to improve adherence
   • Avoid ACE inhibitor + ARB combinations (potentially harmful) 1

2. Triple therapy (if needed): CCB + ARB + thiazide diuretic 2

3. Resistant hypertension: Consider adding spironolactone, amiloride, doxazosin, or clonidine 1

Special Considerations for Nigerian Patients

• Higher risk of kidney disease: If proteinuria or CKD is present, add an ARB (such as losartan) to the regimen for renoprotection 1

• Salt sensitivity: Emphasize sodium restriction (<2,300 mg/day) as this population often has greater salt sensitivity 1

• DASH diet: Particularly effective in African Americans - rich in fruits, vegetables, and low-fat dairy foods 1

Treatment Targets and Monitoring

• Target BP: <140/90 mmHg for most patients; <130/80 mmHg for those with high cardiovascular risk, diabetes, or CKD 2

• Monitoring schedule:

  • Check BP within 2-4 weeks of starting therapy 1
  • Monthly follow-up after initiation until target BP is reached 2
  • Once controlled, follow up every 3-5 months 2
  • Monitor for CCB side effects: peripheral edema, headache, and flushing 1

Potential Pitfalls to Avoid

1. Using ACE inhibitors or ARBs as monotherapy: Less effective in black patients compared to CCBs or thiazides 2, 1

2. Inadequate dosing: Ensure proper titration to achieve target BP within 3 months 1

3. Ignoring lifestyle modifications: Emphasize weight loss, DASH diet, physical activity, and alcohol moderation alongside medication 1

4. Beta-blocker + diuretic combinations: Use with caution due to increased risk of diabetes, especially in high-risk patients 2

By following this approach with a CCB (preferably amlodipine) as first-line therapy, men of Nigerian origin with hypertension can achieve better blood pressure control and reduced cardiovascular risk.