From the Guidelines
Thiazide-type diuretics, such as chlorthalidone, and calcium channel blockers (CCBs), such as amlodipine, are the preferred blood pressure medications for hypertrophic cardiomyopathy in African Americans. For thiazide-type diuretics, chlorthalidone (starting at 12.5-25 mg/day) is recommended due to its proven effectiveness in reducing cardiovascular outcomes 1. Amlodipine, a CCB, is also effective in lowering blood pressure and reducing cardiovascular events in African Americans with hypertrophic cardiomyopathy 1. These medications help reduce blood pressure, improve diastolic function, and decrease left ventricular outflow tract obstruction, thereby alleviating symptoms like chest pain, shortness of breath, and palpitations.
- Key considerations for treatment include:
- Individualizing treatment based on symptom severity, comorbidities, and side effect profiles
- Regular monitoring of blood pressure, heart rate, and symptoms to adjust dosing appropriately
- Avoiding dehydration and excessive alcohol consumption, which can worsen symptoms
- Considering the addition of hydralazine and isosorbide dinitrate for African American patients with persistent symptoms despite optimal treatment with ACE inhibitors, ARBs, and beta blockers 1 It is essential to prioritize the single most recent and highest quality study, which in this case is 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. This guideline provides the most up-to-date and evidence-based recommendations for the management of hypertension in African Americans with hypertrophic cardiomyopathy.
From the FDA Drug Label
In patients with hypertrophic cardiomyopathy (IHSS), alpha-adrenergic agents (phenylephrine HCl, metaraminol bitartrate, or methoxamine HCl) should be used to maintain blood pressure, and isoproterenol and norepinephrine should be avoided
The best blood pressure medication for hypertrophic cardiomyopathy in African Americans is not directly stated in the provided drug label. However, it does mention that alpha-adrenergic agents such as phenylephrine HCl, metaraminol bitartrate, or methoxamine HCl should be used to maintain blood pressure in patients with hypertrophic cardiomyopathy.
- Verapamil is mentioned as a treatment option, but its use is not specifically recommended for African Americans with hypertrophic cardiomyopathy.
- The label does not provide information on the best medication for this specific population, and no conclusion can be drawn regarding the most effective treatment option 2.
From the Research
Blood Pressure Medications for Hypertrophic Cardiomyopathy in African Americans
- The management of hypertension in African Americans is crucial due to the high prevalence of hypertension and its consequences in this population 3.
- African American patients with hypertrophic cardiomyopathy (HCM) may require different treatment approaches, including the use of diuretics and calcium channel blockers, which may be more effective than ACE inhibitors, angiotensin receptor blockers, and beta blockers in this population 3.
- Beta blockers are commonly used to treat HCM, but their effectiveness may be influenced by the presence of chronotropic incompetence, which is common in patients receiving beta blockers 4.
- Verapamil, a calcium channel blocker, has been shown to be effective in improving symptoms and exercise tolerance in patients with HCM, and its use is not associated with a higher incidence of adverse events than beta blockers 5, 6.
- Mavacamten, a new treatment for obstructive HCM, has been shown to improve exercise capacity and symptoms in patients with HCM, regardless of beta blocker use 4.
Treatment Options
- Diuretics and calcium channel blockers may be effective treatment options for African American patients with HCM 3.
- Beta blockers, such as those used in the treatment of HCM, may be less effective in African American patients due to differences in responsiveness to monotherapy 3.
- Verapamil and other calcium channel blockers may be useful alternatives to beta blockers in the treatment of HCM in African American patients 5, 6.
- Mavacamten may be a useful treatment option for patients with obstructive HCM, regardless of beta blocker use 4.
Considerations
- The choice of blood pressure medication for HCM in African Americans should be individualized, taking into account the patient's specific needs and medical history 3.
- Further research is needed to fully understand the effects of different blood pressure medications on HCM in African American patients 7.