Management of High Blood Pressure in Blacks

TLDR

Since the 2003 International Society on Hypertension in Blacks consensus, additional clinical trials have expanded data on hypertension in African Americans. The update divides hypertensive blacks into primary and secondary prevention strata, recommending targets of <135/85 mm Hg and <130/80 mm Hg respectively, and prescribes monotherapy with a diuretic or calcium‑channel blocker for modest elevations, escalating to two‑drug regimens—either a calcium‑channel blocker plus an RAAS blocker or a thiazide plus an RAAS blocker—when elevations exceed 15/10 mm Hg, with up to four‑drug combinations and lifestyle changes for BP ≥115/75 mm Hg. The consensus lowers the minimum target BP for lowest‑risk blacks, stresses effective multidrug regimens, and de‑emphasizes monotherapy.

Abstract

Since the first International Society on Hypertension in Blacks consensus statement on the “Management of High Blood Pressure in African American” in 2003, data from additional clinical trials have become available. We reviewed hypertension and cardiovascular disease prevention and treatment guidelines, pharmacological hypertension clinical end point trials, and blood pressure–lowering trials in blacks. Selected trials without significant black representation were considered. In this update, blacks with hypertension are divided into 2 risk strata, primary prevention, where elevated blood pressure without target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease for whom blood pressure consistently &lt;135/85 mm Hg is recommended, and secondary prevention, where elevated blood pressure with target organ damage, preclinical cardiovascular disease, and/or a history of cardiovascular disease, for whom blood pressure consistently &lt;130/80 mm Hg is recommended. If blood pressure is ≤10 mm Hg above target levels, monotherapy with a diuretic or calcium channel blocker is preferred. When blood pressure is &gt;15/10 mm Hg above target, 2-drug therapy is recommended, with either a calcium channel blocker plus a renin-angiotensin system blocker or, alternatively, in edematous and/or volume-overload states, with a thiazide diuretic plus a renin-angiotensin system blocker. Effective multidrug therapeutic combinations through 4 drugs are described. Comprehensive lifestyle modifications should be initiated in blacks when blood pressure is ≥115/75 mm Hg. The updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks lowers the minimum target blood pressure level for the lowest-risk blacks, emphasizes effective multidrug regimens, and de-emphasizes monotherapy.