nesbitt_Cardiology_book_temp 20/10/2009 13:34 Page 59
Management of Hypertension in African-Americans
Shawna D Nesbitt, MD, MS
Associate Professor of Internal Medicine, University of Texas Southwestern Medical Center
The prevalence of hypertension and its consequences remain high in African-Americans, and both treatment and control are lagging behind
that seen in the general population. The reasons for this phenomenon are found in physiological, cultural, and socioeconomic differences. It
is important to properly frame these differences in the approach to management of blood pressure in this high-risk population. In this article,
these factors are discussed along with a review of recent clinical trial implications for treatment approaches in African-Americans. In
managing African-American patients with hypertension, it is important to: assess the overall cardiovascular risk and blood pressure goal;
define the amount of blood pressure reduction required; select the drug according to the patient’s clinical profile; choose the dose
according to the dose–response curve for ethnic populations, if known; consider the socioeconomic, lifestyle, and educational
background of the patient in making drug choices; and, most importantly, educate patients on the disease, treatment, expectations,
and lifestyle recommendations.
Hypertension, high blood pressure, African-Americans, blacks, ethnic disparity, cardiovascular disease, clinical trials, epidemiology, treatment
Disclosure: Shawna D Nesbitt, MD, MS, is a consultant or on the speaker’s bureau for Novartis, Boehringer Ingelheim, BMS-Sanofi, Forest Pharmaceuticals, and Daichii Sankyo
Pharmaceuticals, and carries out research for Forest Pharmaceuticals.
Received: August 28, 2009 Accepted: September 18, 2009
Correspondence: Shawna D Nesbitt MD, MS, Associate Professor of Internal Medicine, University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd, U9.408, Dallas,
TX 75390-8586. E: Shawna.Nesbitt@UTSouthwestern.edu
Epidemiology Contributing Factors to Hypertension Disparity
Hypertension is both more common and more destructive in and Treatment in African-Americans
African-Americans than in other ethnic groups. According to the There are several physiological and hemodynamic determinants of
2005–2006 National Health and Nutrition Examination Survey hypertension in African-Americans. Although there is speculation about
(NHANES) data, the current prevalence of hypertension in possible differences in etiology and pathophysiology, no single, unique
African-Americans is 39.1%, which is well above non-Hispanic whites cause of hypertension has been identified that explains the high
at 28.5%. While awareness and treatment rates are similar between prevalence of hypertension in African-Americans. Obesity is a major
African-Americans and non-Hispanic whites (66.4 versus 66.9% and contributing factor to hypertension. This association is thought to be
55.0 versus 53.7%, respectively), blood pressure control among all due to an increase in factors such as angiotensin, leptin, and renal
hypertensives is lower in African-Americans (28.9%) compared with medullary compression, leading to increased sympathetic nervous
Furthermore, the mortality rate from hypertension in system activation, and decreased adiponectin, leading to elevated blood
African-American men and women (52.1 and 40.3%, respectively) is pressure and increased cardiovascular risk.
Harshfield and others
higher than in non-Hispanic white men and women (15.8 and 15.1%, have shown that obese African-Americans have higher rates of
Similarly, the disparity in hypertension is prominent in sodium retention than whites, and that the percent body fat is related
children. The estimated prevalence of elevated blood pressure to sodium retention.
Importantly, the prevalence of obesity is highest in
(including hypertension and pre-hypertension) is higher among African-American women, at 35.7%. African-Americans have a 51%
African-American compared with white adolescents (24.5 and 17.5%, higher prevalence of obesity, and Hispanics (28.7%) have 21% higher
In an analysis of NHANES data from 1988 to 1994, obesity prevalence compared with whites (23.7%).
The rapid rate of
African-Americans were twice as likely as the other groups growth of obesity in African-Americans in particular predicts a likely
to have four or five cardiovascular risk factors.
The need for increase in hypertension. Another frequently cited etiological factor is
greater attention to the management of blood pressure in salt sensitivity among African-Americans. Salt sensitivity is described as
African-Americans is obvious. an increase in blood pressure in response to a high-salt diet.
© TOUCH BRIEFINGS 2009 59