Best high blood pressure medication for black patients

Drugs commonly used to treat high blood pressure, and prevent heart attacks and strokes, are associated with significantly worse cardiovascular outcomes in hypertensive African Americans compared to whites, according to a new comparative effectiveness research study led by researchers in the Department of Population Health at NYU Langone Medical Center.

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Media Inquiries
High Blood Pressure in Black People
Why Is High Blood Pressure Common in Black People?
High Blood Pressure Risk Factors for Black People
Do You Have High Blood Pressure?
Treating High Blood Pressure in Black People
Making Your High Blood Pressure Treatment Plan Work
Is losartan good for Black patients?
What blood pressure medication should African Americans avoid?
What is first line treatment for hypertension in African American?
What does lisinopril do to Black people?

The study, published on September 15 in the Journal of the American College of Cardiology (JACC), is unique, the authors say, in that it evaluates racial differences in cardiovascular outcomes and mortality between hypertensive black and white patients whose treatment was initiated with angiotensin-converting-enzyme (ACE) inhibitors, outside of a clinical trial.

ACE inhibitors are one of several classes of drugs commonly prescribed to individuals with hypertension to prevent deaths, heart attack, kidney failure, heart failure, and stroke.

Evidence from randomized controlled trials has previously indicated that ACE inhibitors may not provide the same benefits in blacks compared to whites. However, blacks have been largely underrepresented in the majority of these studies, despite the fact they have disproportionately higher rates of hypertension-related morbidity and mortality than other racial and ethnic groups, according to study authors.

“We know what works in clinical trials. But when you go into the real world clinical practice setting, physicians don’t often translate that evidence into practice. This is the first study that looks at this issue in a real-world, clinical practice setting,” says Gbenga Ogedegbe, MD, MPH, lead author of the study and a professor in the Department of Population Health at NYU Langone.

Data for the study came from electronic health records of nearly 60,000 patients who have high blood pressure and received care between 2004-2009 within New York City’s Health and Hospital Corporation (HHC). HHC operates all public hospitals and clinics in New York City and is the largest such institution in the country. Approximately 35 percent of patients seen in the HHC system are African American.

The investigators compared rates of all-cause mortality, heart attack, stroke, and congestive heart failure between African American and white patients who were prescribed one of four classes of antihypertensive drugs to treat high blood pressure: ACE inhibitors, beta blockers, calcium-channel blockers, or thiazide-type diuretics. In African Americans, ACE inhibitor use was associated with a statistically significant rate of poorer cardiovascular outcomes (8.7 percent compared to 7.7 percent) but not in whites (6.4 percent compared to 6.74 percent). African Americans were no more likely than whites to have adverse effects linked to use of ACE inhibitors.

The reasons for the noted racial disparity in clinical effectiveness of ACE inhibitor-based regimes between African Americans and whites remain unclear, though the prevailing theory is that blacks are less responsive to antihypertensive treatment with ACE inhibitors. African Americans are also at greater risk for cardiovascular events than whites.

“The results of this study adds to a growing consensus among physicians that treatment of hypertension in blacks should not be initiated with ACE inhibitors,” said Dr. Ogedegbe, director of Division of Health & Behavior and NYU’s Center for Healthful Behavior Change.

In January, the Joint National Committee recommended initiating other treatments besides ACE inhibitors in patients of African descent, and there are other guidelines in preparation that can be informed by this study, Dr. Ogedegbe noted.

Additional authors of the study include other NYU Langone researchers Sripal Bangalore, MD, and Keith Goldfeld, DrPH.

Dr. Ogedegbe was supported by a grant from the National Heart, Lung, and Blood Institute, K24HL111315, in addition to the AHRQ grant R01HS018589. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The AHRQ did not have any role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of this manuscript.

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High Blood Pressure in Black People

High blood pressure, also known as hypertension, affects Black people in unique ways. It's known to:

Bring on high blood pressure at younger ages than in other groups in the U.S.
Cause complications associated with high blood pressure. These problems include stroke, kidney disease, blindness, dementia, and heart disease.

Why is high blood pressure in Black people so common? If you are Black, what can you do to avoid having high blood pressure? Find out how you can protect yourself from this serious health condition.

Why Is High Blood Pressure Common in Black People?

Researchers do not have a definitive answer to this question, but some believe the following things have something to do with it:

Genetic factors. High rates of high blood pressure in Black people may be due to the genetic makeup of people of African descent. Researchers have uncovered some facts: In the U.S., Black people respond differently to high blood pressure drugs than do other groups of people. African Americans also seem to be more sensitive to salt, which increases the risk of having high blood pressure.
Environmental factors. Some scientists believe that high blood pressure in Black people is due to things unique to the experience of African Americans. Black people worldwide have rates of high blood pressure that are similar to that of white people. But in the U.S., the difference is dramatic: 41% of African Americans have high blood pressure, as compared to 27% of white Americans. In addition, Black people in the U.S are more likely to be overweight than Black people in other countries. Some experts think that social and economic factors – including discrimination and economic inequality – are responsible for this difference.

Researchers will hopefully find the causes for the high incidence of high blood pressure in Black people. In the meantime, there is a lot you can do to keep high blood pressure from damaging your health.

High Blood Pressure Risk Factors for Black People

Being Black is a risk factor for developing high blood pressure. Others include:

Increased age
Excessive weight
A family history of high blood pressure
Having diabetes
Inactivity
Lots of salt and fat in your diet
Not getting enough potassium
Smoking

The more risk factors you have, the more likely it is that you have high blood pressure or will get it in the future. Take steps now to find out more. Even if you don't have high blood pressure, you can lower your risk by following the treatment guidelines for high blood pressure in Black people.

Do You Have High Blood Pressure?

Your doctor can easily measure blood pressure. A blood pressure reading includes two numbers, one written on top of the other.

The top number is called your systolic blood pressure. This number represents the force of blood through your blood vessels during your heartbeat.

119 or below is the normal systolic blood pressure.
120-129 is elevated.
130-139 and greater is Stage 1 high blood pressure.
140 and higher is Stage 2 high blood pressure.
180 or above is hypertensive crisis. Call 911 immediately.

The bottom number is called your diastolic blood pressure. This number represents the force of blood through your blood vessels in between heartbeats, while your heart is resting.

79 or below is normaldiastolic blood pressure.
79 or below, combined with 120-129 systolic, is elevated.
80-89 is Stage 1 high blood pressure
90 and greater is Stage 2 high blood pressure.

Blood pressure changes throughout the day, depending on your activities. Blood pressure changes over time, as well. Systolic blood pressure tends to rise as you get older. Diastolic blood pressure may decrease as you get older.

If either of your blood pressure readings is consistently above normal, then take action right away. Work with your doctor to develop a plan to treat high blood pressure before damage to your organs occurs.

Treating High Blood Pressure in Black People

If you have high blood pressure, consult your doctor to find which combination of treatments works best, given your individual health and lifestyle. Your treatment plan is likely to include the following elements:

Follow the DASH eating plan. The Dietary Approaches to Stop Hypertension (DASH) diet plan includes eating less fat and saturated fat, as well as eating more fresh fruits and vegetables and whole-grain food. Limiting alcohol consumption can also help lower your blood pressure. A dietitian can help you find ways to meet these goals without giving up your favorite foods.
Limit salt intake. Because Black people seem more sensitive to salt, it makes sense to watch how much salt you eat. Table salt and sodium used in processed foods are the two sources of sodium in your diet. Consult a dietitian to learn how to select and prepare tasty, low-salt meals.
Watch your weight. Being overweight increases your risk of high blood pressure. Following the DASH eating plan and getting regular exercise can help you lose weight. Ask your doctor to help you determine a goal. Your doctor can also refer you to other health care professionals for help in setting up a weight loss plan.
Quit smoking.Tobacco smoke can make blood pressure rise. It can also directly damage your heart and blood vessels. Talk with your doctor about ways to quit.
Medication. Your doctor may prescribe medication to control your high blood pressure. It's common to take more than one drug to treat the problem. Your doctor may ask you to switch drugs or change the dosage until you find a combination that works best to control high blood pressure with the least side effects for you. Drugs used to treat high blood pressure include:
Diuretics, which reduce the amount of fluid in your blood by helping your body rid itself of extra salt. This type of blood pressure medication should be used in most cases to treat high blood pressure.
Calcium channel blockers, ACE inhibitors, and alpha-blockers help keep your blood vessels from tightening up. Your doctor may want to start with calcium channel blockers by themselves, or in combination with diuretics.
Beta-blockers prevent your body from using the hormone adrenaline by blocking the cell receptors for it. Adrenaline is a stress hormone. It makes your heart beat harder and faster. It also makes your blood vessels tighten. All of this makes blood pressure higher.

Making Your High Blood Pressure Treatment Plan Work

To be sure your high blood pressure treatment plan is working, follow these steps:

Check your blood pressure as often as recommended by your doctor.
Follow your treatment plan consistently. Let your doctor know right away if you have problems with part of the plan. Your doctor may refer you to other health care professionals who can help.
See your doctor as often as requested. Bring your blood pressure records to show your doctor how well the plan is working.
Ask your doctor or pharmacist for information about medication side effects. Know when to call your doctor if there is a problem.

Your knowledge about the risk of high blood pressure in Black people is the first step in controlling this condition, so you can remain as healthy as possible for years to come.

Is losartan good for Black patients?

Conclusions: The results of this study suggest that in African American patients, losartan monotherapy was significantly more effective than placebo in lowering SiSBP and SiDBP.

What blood pressure medication should African Americans avoid?

In African Americans, ACE inhibitor use was associated with a statistically significant rate of poorer cardiovascular outcomes (8.7 percent compared to 7.7 percent) but not in whites (6.4 percent compared to 6.74 percent).

What is first line treatment for hypertension in African American?

First‐line therapy for the treatment of hypertension in African Americans as recommended by JNC VI includes diuretics or a low‐dose combination of a diuretic and β blocker. Calcium channel antagonists are an acceptable alternative when added to previously existing diuretic monotherapy.

What does lisinopril do to Black people?

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) ...