October 5, 2010
View Full PaperManagement of High Blood Pressure in Blacks
Key Result
The updated consensus statement on hypertension management in blacks recommends target blood pressures of <135/85 mm Hg for primary prevention and <130/80 mm Hg for secondary prevention.
Structured PICO
What are the optimal blood pressure targets and pharmacological treatment strategies for managing hypertension in Black patients?
P
Population
Blacks with hypertension, categorized into primary prevention (no target organ damage or cardiovascular disease) and secondary prevention (target organ damage, preclinical cardiovascular disease, and/or history of cardiovascular disease).
I
Intervention
Blood pressure management with specific targets (<135/85 mm Hg for primary prevention, <130/80 mm Hg for secondary prevention) and pharmacological strategies (diuretic or calcium channel blocker monotherapy if ≤10 mm Hg above target; calcium channel blocker or thiazide diuretic plus a renin-angiotensin system blocker if >15/10 mm Hg above target).
This consensus statement provides updated, more stringent blood pressure targets and specific pharmacological recommendations for managing hypertension in Black patients.
Abstract
Since the first International Society on Hypertension in Blacks consensus statement on the "Management of High Blood Pressure in African American" in 2003, data from additional clinical trials have become available. We reviewed hypertension and cardiovascular disease prevention and treatment guidelines, pharmacological hypertension clinical end point trials, and blood pressure-lowering trials in blacks. Selected trials without significant black representation were considered. In this update, blacks with hypertension are divided into 2 risk strata, primary prevention, where elevated blood pressure without target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease for whom blood pressure consistently 15/10 mm Hg above target, 2-drug therapy is recommended, with either a calcium channel blocker plus a renin-angiotensin system blocker or, alternatively, in edematous and/or volume-overload states, with a thiazide diuretic plus a renin-angiotensin system blocker. Effective multidrug therapeutic combinations through 4 drugs are described. Comprehensive lifestyle modifications should be initiated in blacks when blood pressure is ≥115/75 mm Hg. The updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks lowers the minimum target blood pressure level for the lowest-risk blacks, emphasizes effective multidrug regimens, and de-emphasizes monotherapy.