What is the best treatment for hypertension in African Americans?

Shobha Rao, Manjula Cherukuri, Helen G. Mayo

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Three large cohort studies determined that African Americans have a higher prevalence of hypertension and worse cardiovascular and renal outcomes when compared with white Americans. For African American patients, the standard blood pressure goals apply: below 140/90 mm Hg with uncomplicated hypertension and below 130/80, with diabetes or renal disease. Dietary interventions An RCT compared the effects of consuming the DASH diet (consisting of 4-5 servings of fruit, 4-5 servings of vegetables, 2-3 servings of low-fat dairy per day, and 55 years, compared chlorthalidone (a thiazide-type diuretic) with amlodipine (Norvasc), lisinopril (Prinivil, Zestril), or doxazosin (Cardura). In this study, which included 36% African Americans, chlorthalidone, lisinopril, and amlodipine did not differ in preventing major cardiovascular events. However, lisinopril was associated with an increased risk for heart failure (relative risk [RR] for African Americans=1.32; 95% CI, 1.11-1.58) and stroke (RR for African Americans=1.4; 95% CI, 1.17-1.68), and amlodipine was associated with a higher risk of heart failure (RR in African Americans=1.47; 95% CI, 1.24-1.74). Additionally, ACE inhibitor-induced angioedema or cough occurred more frequently among African American patients than white patients. Although a randomized controlled trial and a review of multiple studies demonstrated that African Americans may be less responsive to monotherapy with ACE inhibitors, the AASK trial confirmed that ACE inhibitors can provide significant clinical benefits for African Americans with hypertensive renal disease. AASK, a double-blind RCT of 1094 African American patients with renal insufficiency, compared the effects of an ACE inhibitor (ramipril [Altace]), a dihydropyridine calcium channel blocker (amlodipine), or a beta blocker (metoprolol [Lopressor]) on the progression of hypertensive renal disease. The study showed a 44% relative risk reduction (95% CI, 13%-65%; number needed to treat [NNT]=25) in progression to end-stage renal disease, and a significant decrease in the combined endpoints of glomerular filtration rate events (decrease >50%), end-stage renal disease, and death (decreased by 38%) in the ramipril group compared with the amlodipine group (95% CI, 13%-56%; NNT=56 per patient-year). Metoprolol appeared to have intermediate outcomes.

Original languageEnglish (US)
Pages (from-to)149-151
Number of pages3
JournalJournal of Family Practice
Volume56
Issue number2
StatePublished - Feb 2007
Externally publishedYes

Fingerprint

African Americans
Amlodipine
Hypertension
Lisinopril
Ramipril
Angiotensin-Converting Enzyme Inhibitors
Metoprolol
Chlorthalidone
Doxazosin
Kidney
Therapeutics
Numbers Needed To Treat
Chronic Kidney Failure
Heart Failure
Sodium Chloride Symporter Inhibitors
Angioedema
Calcium Channel Blockers
Risk Reduction Behavior
Glomerular Filtration Rate
Cough

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Medicine(all)

Cite this

Rao, S., Cherukuri, M., & Mayo, H. G. (2007). What is the best treatment for hypertension in African Americans? Journal of Family Practice, 56(2), 149-151.

What is the best treatment for hypertension in African Americans? / Rao, Shobha; Cherukuri, Manjula; Mayo, Helen G.

In: Journal of Family Practice, Vol. 56, No. 2, 02.2007, p. 149-151.

Research output: Contribution to journalArticle

Rao, S, Cherukuri, M & Mayo, HG 2007, 'What is the best treatment for hypertension in African Americans?', Journal of Family Practice, vol. 56, no. 2, pp. 149-151.
Rao, Shobha ; Cherukuri, Manjula ; Mayo, Helen G. / What is the best treatment for hypertension in African Americans?. In: Journal of Family Practice. 2007 ; Vol. 56, No. 2. pp. 149-151.
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