Advertisement

Hypertension Management in African Americans: The AASK and Other Landmark Trial Application

  • Ping Li
  • Annise K. Chung
  • Samir S. Patel
  • Vasilios Papademetriou
Chapter

Abstract

Hypertension is a major public health challenge and affects 120 million adults in the United States. Recent hypertension trial outcomes indicate that further lowering of blood pressure below the standard target may reduce mortality (Group et al., N Engl J Med 373(22):2103–2116, 2015) which is now reflected in the latest treatment guidelines that have lowered the target blood pressure to 130/80 mmHg (Whelton et al., Hypertension 71:e13–e115, 2018). The excess burden of hypertension among African-Americans was recognized in the early twentieth century and largely contributes to the excessive morbidity and mortality seen in this population compared to other racial/ethnic groups. It is well documented that hypertension in African-Americans is more prevalent, has an earlier onset, increased severity and results in more complications than other populations (Flack et al., Curr Cardiol Rep 14(6):660–666, 2012). Despite treatment advances, improved access to health care, and similar control rates across most racial groups, African-Americans continue to experience high rates of hypertension attributable complications such as end stage renal disease (ESRD), heart failure and stroke. A comprehensive approach for effective management of hypertension in the African-American population is crucial to address this important health disparity. The pathogenesis, new hypertension guidelines and clinical trial outcomes related to African-Americans, specifically the African American Study of Kidney Disease and Hypertension (AASK) trial, will be discussed in this chapter. The term “African-American” or “Black” patients will refer to all people of African ancestry living in the USA.

Keywords

African Americans AASK trial Arterial hypertension Complications Epidemiology Pathogenesis Clinical application Recommendations 

References

  1. 1.
    Group SR, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16.CrossRefGoogle Scholar
  2. 2.
    Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115.PubMedGoogle Scholar
  3. 3.
    Flack JM, Okwuosa T, Sudhakar R, Ference B, Levy P. Should African Americans have a lower blood pressure goal than other ethnic groups to prevent organ damage? Curr Cardiol Rep. 2012;14(6):660–6.CrossRefGoogle Scholar
  4. 4.
    Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: national health and nutrition examination survey, 2011–2012. NCHS Data Brief. 2013;(133):1–8.Google Scholar
  5. 5.
    Flack JM, Nasser SA, Levy PD. Therapy of hypertension in African Americans. Am J Cardiovasc Drugs. 2011;11(2):83–92.CrossRefGoogle Scholar
  6. 6.
    Fletcher RD, Amdur RL, Kolodner R, McManus C, Jones R, Faselis C, et al. Blood pressure control among US veterans: a large multiyear analysis of blood pressure data from the Veterans Administration Health Data Repository. Circulation. 2012;125(20):2462–8.CrossRefGoogle Scholar
  7. 7.
    Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–e292.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, et al. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation. 2017;136(21):e393–423.CrossRefGoogle Scholar
  9. 9.
    Bibbins-Domingo K, Pletcher MJ, Lin F, Vittinghoff E, Gardin JM, Arynchyn A, et al. Racial differences in incident heart failure among young adults. N Engl J Med. 2009;360(12):1179–90.CrossRefGoogle Scholar
  10. 10.
    Will JC, Nwaise IA, Schieb L, Zhong Y. Geographic and racial patterns of preventable hospitalizations for hypertension: Medicare beneficiaries, 2004–2009. Public Health Rep. 2014;129(1):8–18.CrossRefGoogle Scholar
  11. 11.
    Musemwa N, Gadegbeku CA. Hypertension in African Americans. Curr Cardiol Rep. 2017;19(12):129.CrossRefGoogle Scholar
  12. 12.
    Adeyemo A, Gerry N, Chen G, Herbert A, Doumatey A, Huang H, et al. A genome-wide association study of hypertension and blood pressure in African Americans. PLoS Genet. 2009;5(7):e1000564.CrossRefGoogle Scholar
  13. 13.
    Kidambi S, Ghosh S, Kotchen JM, Grim CE, Krishnaswami S, Kaldunski ML, et al. Non-replication study of a genome-wide association study for hypertension and blood pressure in African Americans. BMC Med Genet. 2012;13:27.CrossRefGoogle Scholar
  14. 14.
    Franceschini N, Fox E, Zhang Z, Edwards TL, Nalls MA, Sung YJ, et al. Genome-wide association analysis of blood-pressure traits in African-ancestry individuals reveals common associated genes in African and non-African populations. Am J Hum Genet. 2013;93(3):545–54.CrossRefGoogle Scholar
  15. 15.
    Parsa A, Kao WH, Xie D, Astor BC, Li M, Hsu CY, et al. APOL1 risk variants, race, and progression of chronic kidney disease. N Engl J Med. 2013;369(23):2183–96.CrossRefGoogle Scholar
  16. 16.
    Tin A, Grams ME, Estrella M, Lipkowitz M, Greene TH, Kao WH, et al. Patterns of kidney function decline associated with APOL1 genotypes: results from AASK. Clin J Am Soc Nephrol. 2016;11(8):1353–9.CrossRefGoogle Scholar
  17. 17.
    Nadkarni GN, Wyatt CM, Murphy B, Ross MJ. APOL1: a case in point for replacing race with genetics. Kidney Int. 2017;91(4):768–70.CrossRefGoogle Scholar
  18. 18.
    Chen TK, Appel LJ, Grams ME, Tin A, Choi MJ, Lipkowitz MS, et al. APOL1 risk variants and cardiovascular disease: results from the AASK (African American Study of Kidney Disease and Hypertension). Arterioscler Thromb Vasc Biol. 2017;37(9):1765–9.CrossRefGoogle Scholar
  19. 19.
    Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment–a position paper of the The Obesity Society and The American Society of Hypertension. Obesity (Silver Spring). 2013;21(1):8–24.CrossRefGoogle Scholar
  20. 20.
    Madhavan S, Alderman MH. Ethnicity and the relationship of sodium intake to blood pressure. J Hypertens. 1994;12(1):97–103.CrossRefGoogle Scholar
  21. 21.
    Weinberger MH. Salt sensitivity of blood pressure in humans. Hypertension. 1996;27(3 Pt 2):481–90.CrossRefGoogle Scholar
  22. 22.
    Bankir L, Bochud M, Maillard M, Bovet P, Gabriel A, Burnier M. Nighttime blood pressure and nocturnal dipping are associated with daytime urinary sodium excretion in African subjects. Hypertension. 2008;51(4):891–8.CrossRefGoogle Scholar
  23. 23.
    Sanders PW. Dietary salt intake, salt sensitivity, and cardiovascular health. Hypertension. 2009;53(3):442–5.CrossRefGoogle Scholar
  24. 24.
    Price DA, Fisher ND. The renin-angiotensin system in blacks: active, passive, or what? Curr Hypertens Rep. 2003;5(3):225–30.CrossRefGoogle Scholar
  25. 25.
    Boddi M, Poggesi L, Coppo M, Zarone N, Sacchi S, Tania C, et al. Human vascular renin-angiotensin system and its functional changes in relation to different sodium intakes. Hypertension. 1998;31(3):836–42.CrossRefGoogle Scholar
  26. 26.
    Michel FS, Norton GR, Maseko MJ, Majane OH, Sareli P, Woodiwiss AJ. Urinary angiotensinogen excretion is associated with blood pressure independent of the circulating renin-angiotensin system in a group of african ancestry. Hypertension. 2014;64(1):149–56.CrossRefGoogle Scholar
  27. 27.
    Taherzadeh Z, Brewster LM, van Montfrans GA, VanBavel E. Function and structure of resistance vessels in black and white people. J Clin Hypertens (Greenwich). 2010;12(6):431–8.CrossRefGoogle Scholar
  28. 28.
    Campia U, Cardillo C, Panza JA. Ethnic differences in the vasoconstrictor activity of endogenous endothelin-1 in hypertensive patients. Circulation. 2004;109(25):3191–5.CrossRefGoogle Scholar
  29. 29.
    Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007;50(1):197–203.CrossRefGoogle Scholar
  30. 30.
    Safar ME, Blacher J, Pannier B, Guerin AP, Marchais SJ, Guyonvarc'h PM, et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension. 2002;39(3):735–8.CrossRefGoogle Scholar
  31. 31.
    Heffernan KS, Jae SY, Wilund KR, Woods JA, Fernhall B. Racial differences in central blood pressure and vascular function in young men. Am J Physiol Heart Circ Physiol. 2008;295(6):H2380–7.CrossRefGoogle Scholar
  32. 32.
    Din-Dzietham R, Couper D, Evans G, Arnett DK, Jones DW. Arterial stiffness is greater in African Americans than in whites: evidence from the Forsyth County, North Carolina, ARIC cohort. Am J Hypertens. 2004;17(4):304–13.CrossRefGoogle Scholar
  33. 33.
    Ferdinand KC, Ferdinand DP. Race-based therapy for hypertension: possible benefits and potential pitfalls. Expert Rev Cardiovasc Ther. 2008;6(10):1357–66.CrossRefGoogle Scholar
  34. 34.
    Fuchs FD, Chambless LE, Whelton PK, Nieto FJ, Heiss G. Alcohol consumption and the incidence of hypertension: the Atherosclerosis Risk in Communities Study. Hypertension. 2001;37(5):1242–50.CrossRefGoogle Scholar
  35. 35.
    Redmond N, Baer HJ, Hicks LS. Health behaviors and racial disparity in blood pressure control in the national health and nutrition examination survey. Hypertension. 2011;57(3):383–9.CrossRefGoogle Scholar
  36. 36.
    Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288(19):2421–31.CrossRefGoogle Scholar
  37. 37.
    Appel LJ, Wright JT Jr, Greene T, Agodoa LY, Astor BC, Bakris GL, et al. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010;363(10):918–29.CrossRefGoogle Scholar
  38. 38.
    Ku E, Gassman J, Appel LJ, Smogorzewski M, Sarnak MJ, Glidden DV, et al. BP control and long-term risk of ESRD and mortality. J Am Soc Nephrol. 2017;28(2):671–7.CrossRefGoogle Scholar
  39. 39.
    Norris K, Bourgoigne J, Gassman J, Hebert L, Middleton J, Phillips RA, et al. Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial. Am J Kidney Dis. 2006;48(5):739–51.CrossRefGoogle Scholar
  40. 40.
    Flack JM, Sica DA. Therapeutic considerations in the African-American patient with hypertension: considerations with calcium channel blocker therapy. J Clin Hypertens (Greenwich). 2005;7(4 Suppl 1):9–14.CrossRefGoogle Scholar
  41. 41.
    Officers A, Coordinators for the ACRGTA, Lipid-Lowering Treatment to Prevent Heart Attack T. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981–97.CrossRefGoogle Scholar
  42. 42.
    Wright JT Jr, Dunn JK, Cutler JA, Davis BR, Cushman WC, Ford CE, et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. 2005;293(13):1595–608.CrossRefGoogle Scholar
  43. 43.
    Leenen FH, Nwachuku CE, Black HR, Cushman WC, Davis BR, Simpson LM, et al. Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension. 2006;48(3):374–84.CrossRefGoogle Scholar
  44. 44.
    Group AS, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575–85.CrossRefGoogle Scholar
  45. 45.
    Still CH, Rodriguez CJ, Wright JT Jr, Craven TE, Bress AP, Chertow GM, et al. Clinical outcomes by race and ethnicity in the Systolic Blood Pressure Intervention Trial (SPRINT): a randomized clinical trial. Am J Hypertens. 2017;31(1):97–107.CrossRefGoogle Scholar
  46. 46.
    Flack JM, Sica DA, Bakris G, Brown AL, Ferdinand KC, Grimm RH Jr, et al. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010;56(5):780–800.CrossRefGoogle Scholar
  47. 47.
    Jones DW, Hall JE. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and evidence from new hypertension trials. Hypertension. 2004;43(1):1–3.CrossRefGoogle Scholar
  48. 48.
    McManus RJ, Caulfield M, Williams B, National Institute for H, Clinical E. NICE hypertension guideline 2011: evidence based evolution. BMJ. 2012;344:e181.CrossRefGoogle Scholar
  49. 49.
    Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2014;63(4):878–85.CrossRefGoogle Scholar
  50. 50.
    Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich). 2014;16(1):14–26.CrossRefGoogle Scholar
  51. 51.
    Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, et al. Hypertension Canada’s 2016 Canadian hypertension education program guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2016;32(5):569–88.CrossRefGoogle Scholar
  52. 52.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Ping Li
    • 1
    • 2
    • 3
  • Annise K. Chung
    • 2
  • Samir S. Patel
    • 1
    • 3
  • Vasilios Papademetriou
    • 4
  1. 1.Washington Veterans Affairs Medical CenterWashington, DCUSA
  2. 2.Georgetown University HospitalWashington, DCUSA
  3. 3.George Washington University School of MedicineWashington, DCUSA
  4. 4.Georgetown University and VA Medical CenterWashington, DCUSA

Personalised recommendations