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Should African Americans with Hypertension Be Treated Differently than Non-African Americans?

  • Therapeutic Trials (B Pitt, Section Editor)
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Abstract

African Americans have a higher burden of hypertension, more severe blood pressure (BP) elevations, more concurrent risk-enhancing co-morbidities (e.g., diabetes), sub-clinical vascular injury at lower non-hypertensive BP levels, lower BP control rates, and significantly greater risk for adverse pressure-related clinical complications (e.g., stroke, heart failure) than whites. Randomized prospective data from hypertension endpoint trials show a virtually identical percentage reduction in CVD risk for a given magnitude of BP lowering, irrespective of the presence or absence of pre-treatment CVD across a broad range of BP down to pre-treatment BP levels of 110/70 mm Hg. These data, mostly emanating from white populations, do not necessarily inform practitioners as to the level below which BP should be lowered in those with established, long-standing hypertension; however, these data do provide support for initiating hypertension treatment at lower than conventional BP thresholds. A Mendelian randomized study examining the impact of life-long lower SBP levels showed that lifelong exposure to 10 mm Hg lower SBP was associated with an 82 % lesser rate of SBP rise per decade and a 58 % lower CHD risk that was much greater than the 22 % reduction in CHD reported for the same magnitude of SBP reduction in clinical trials. Arguably, it is the hypertension treatment paradigm that merits reexamination. Earlier hypertension treatment in all populations prior to the onset of significant pressure-related target organ injury might conceivably prevent, or at least significantly attenuate, the well documented age-related rise in BP seen in most Western societies. In addition, this treatment paradigm might also reduce the significant residual CVD risk observed under the current recommended approach to hypertension treatment. This new approach to therapy would likely have substantial clinical and public health benefits in the high-risk, under-treated African American population that suffers outsized devastating consequences from inadequate control of BP.

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Conflict of Interest

Brian A. Ference and Philip Levy declare that both have no conflict of interest.

John M. Flack has received a grant from the National Institutes of Health, Novartis, Medtronic. He is a consultant to Novartis, Medtronic and Back Beat Hypertension.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Translational Research and Clinical Epidemiology, Department of Medicine, Wayne State University, Detroit, MI, USA

    John M. Flack & Brian A. Ference

  2. Division of Endocrinology, Metabolism, and Hypertension, Department of Medicine, Wayne State University, Detroit, MI, USA

    John M. Flack

  3. Department of Physiology, Wayne State University, Detroit, MI, USA

    John M. Flack

  4. Department of Medicine, Division of Translational Research and Clinical Epidemiology, Wayne State University, 4201 St. Antoine, Suite 2E-University Health Center, Detroit, MI, 48201, USA

    John M. Flack

  5. Division of Cardiology, Department of Medicine, Wayne State University, Detroit, MI, USA

    Brian A. Ference

  6. Department of Emergency Medicine, Department of Medicine, Wayne State University, Detroit, MI, USA

    Phillip Levy

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  1. John M. Flack
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  2. Brian A. Ference
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Correspondence to John M. Flack.

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This article is part of the Topical Collection on Therapeutic Trials

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Flack, J.M., Ference, B.A. & Levy, P. Should African Americans with Hypertension Be Treated Differently than Non-African Americans?. Curr Hypertens Rep 16, 409 (2014). https://doi.org/10.1007/s11906-013-0409-5

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  • DOI: https://doi.org/10.1007/s11906-013-0409-5

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