Title: management of hypertensive disease in Black patients | QJM: An International Journal of Medicine | Oxford Academic
Headings: The management of hypertensive disease in Black patients
The management of hypertensive disease in Black patients
Published:
Abstract
Introduction
Incidence and complications
Pathophysiology
Non-pharmacological management
Sodium restriction
Weight control
Alcohol
Exercise
Pharmacological management
Diuretics
Beta-blockers
Angiotensin-converting enzyme (ACE) inhibitors
Calcium channel-blockers
Alpha-blockers
Angiotensin receptor antagonists
Recommendations
References
J Cardiovasc Pharmacol

Content: 2 In addition, there is a greater tendency to develop left ventricular hypertrophy (LVH); Black patients with mild hypertension have a two-fold higher prevalence of LVH when compared to non-Blacks with comparable blood pressure levels. 3
Despite an increased prevalence of both hypertension and diabetes, 4 the overall risk of coronary artery disease in the Black male population, in Europe, in the Caribbean and to a lesser extent in North America, is lower than in White males. 5 By contrast, Indo-Asians have an excess prevalence of coronary artery disease. This contrast may be due to a multitude of reasons, although many of the traditional risk factors do not fully explain the ethnic differences in cardiovascular disease and stroke. One reason however may be the more favourable lipid profiles, seen particularly in Black males, with higher high-density-lipoprotein (HDL) cholesterol levels and lower plasma triglycerides. 5
The increased frequency of cerebrovascular disease, renal complications and cardiac hypertrophy in Black patients may be related to a higher incidence of severe hypertension, including malignant hypertension. The West Birmingham Malignant Hypertension Register, for example, revealed that there was an excess of Black patients with malignant hypertension, who also had higher blood pressures and more severe renal impairment at presentation; such patients had a poorer overall median survival and an increased rate of progression to dialysis. 6 Thus, Black patients with malignant hypertension did not do worse simply because they were Black, but they appeared to have poorer blood pressure control and more complications, such as renal damage.