Hypertension Treatment in Blacks: Discussion of the U.S. Clinical Practice Guidelines.
Blacks are especially susceptible to hypertension (HTN) and its associated organ damage leading to adverse cardiovascular, cerebrovascular and renal outcomes. Accordingly, HTN is particularly significant in contributing to the black-white racial differences in health outcomes in the US. As such, in order to address these health disparities, practical clinical practice guidelines (CPGs) on how to treat HTN, specifically in blacks, are needed. This review article is a timely addition to the literature because the most recent U.S. CPG more explicitly emphasizes race into the algorithmic management of HTN. However, recent clinical research cautions that use of race as a proxy to determine therapeutic response to pharmaceutical agents may be erroneous. This review will address the implications of the use of race in the hypertension CPGs. We will review the rationale behind the introduction of race into the U.S. CPG and the level of evidence that was available to justify this introduction. Finally, we will conclude with practical considerations in the treatment of HTN in blacks.
Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, New York, NY 10016. Electronic address: stephen.williams@nyumc.org.
Stephen K
SK
Williams
Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, New York, NY 10016.
Joseph
J
Ravenell
Department of Medicine, Rutgers-Robert Wood Johnson Medical School, Jersey Shore University Medical Center, Neptune, NJ 07753.
Sara
S
Seyedali
Department of Medicine, Rutgers-Robert Wood Johnson Medical School, Jersey Shore University Medical Center, Neptune, NJ 07753.
Sam
S
Nayef
Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, New York, NY 10016.
Gbenga
G
Ogedegbe
D001741:Black or African American; D019468:Disease Management; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000628:therapy; D017410:Practice Guidelines as Topic; D014481:United States
African Americans; Blacks; Hypertension; Minorities
Ann N Y Acad Sci. 1999;896:281-93
10681904
Circulation. 2016 Jan 26;133(4):e38-360
26673558
N Engl J Med. 2003 Mar 20;348(12):1166-70
12646675
N Engl J Med. 2016 May 26;374(21):2009-20
27041480
JAMA Intern Med. 2013 Jan 14;173(1):46-51
23229778
Am J Hypertens. 2003 May;16(5 Pt 1):407-15
12745204
Circulation. 2000 Jan 25;101(3):329-35
10645931
N Engl J Med. 2008 Dec 4;359(23):2417-28
19052124
Ann Intern Med. 2014 Apr 1;160(7):499-503
24424788
Curr Hypertens Rep. 2003 Jun;5(3):225-30
12724055
JAMA. 2014 Feb 5;311(5):507-20
24352797
BMJ. 2004 Mar 13;328(7440):634-40
15016698
J Clin Hypertens (Greenwich). 2003 Jan-Feb;5(1 Suppl 1):5-11
12556667
BMJ. 2002 Mar 23;324(7339):699-702
11909785
Arch Intern Med. 2003 Mar 10;163(5):525-41
12622600
Am J Physiol Heart Circ Physiol. 2006 Nov;291(5):H2021-5
16829641
J Renin Angiotensin Aldosterone Syst. 2006 Jun;7(2):61-3
17083059
JAMA. 1991 Jun 26;265(24):3255-64
2046107
N Engl J Med. 2001 May 3;344(18):1392-3
11333999
Stroke. 2015 Jun;46(6):1595-600
25953369
Ann Intern Med. 2007 Jan 2;146(1):57-62
17200223
JAMA. 1977 Jan 17;237(3):255-61
576159
Hypertension. 2004 Jun;43(6):1182-8
15123573
Circulation. 2011 Aug 30;124(9):1046-58
21824920
Hypertension. 2005 Jul;46(1):124-9
15939807
J Am Soc Hypertens. 2015 Sep;9(9):670-9
26320890
JAMA. 1967 Dec 11;202(11):1028-34
4862069
N Engl J Med. 2008 May 1;358(18):1887-98
18378519
Hypertension. 2010 Nov;56(5):780-800
20921433
J Hypertens. 2007 May;25(5):951-8
17414657
N Engl J Med. 2015 Jun 4;372(23):2229-34
26014593
NCHS Data Brief. 2013 Oct;(133):1-8
24171916
Am J Hypertens. 2004 Jan;17(1):1-7
14700504
JAMA. 1970 Aug 17;213(7):1143-52
4914579