Should African Americans have a lower blood pressure goal than other ethnic groups to prevent organ damage?
African Americans manifest an inordinately high burden of hypertension, pressure-related target-organ injury (eg, left ventricular hypertrophy, stroke), and sub-optimal hypertension control rates to conventional levels (<140/90 mm Hg). A substantive proportion of the excessive premature mortality in African Americans relative to Whites is pressure-related. Randomized prospective pharmacologic hypertension end-point trials have shown invariable cardiovascular disease (CVD) risk reduction across a broad range of pre-treatment BP levels down to 110/70 mm Hg with the magnitude of CVD risk reduction across the 5 major antihypertensive drug classes being directly linked to degree of blood pressure (BP) lowering. Pooled endpoint data from pharmacologic hypertension trials in African Americans showed that CVD risk reduction was the same with major antihypertensive drug classes when similar levels of BP were achieved. A lower than conventional BP target for African Americans seems justified and prudent because attainment of lower BP should incrementally lower CVD risk in this high-risk population.
Department of Medicine, Division of Translational Research and Clinical Epidemiology, Wayne State University, Detroit, MI 48201, USA. jflack@med.wayne.edu
John M
JM
Flack
Tochukwi
T
Okwuosa
Rajeev
R
Sudhakar
Brian
B
Ference
Phillip
P
Levy
D001741:Black or African American; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000517:prevention & control; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000208:ethnology / Q000517:prevention & control*; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology / Q000517:prevention & control
D000959:Antihypertensive Agents