Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Cardiology, Nephrology


Dr. Nnacy Reid




African-Americans have a greater burden of hypertension and target end organ damage in the United States. Lifestyle and dietary modification are important but effective and aggressive therapeutic management of hypertension in African Americans should be initiated early. There are multiple ways of initiating antihypertensives and the selection of antihypertensives are traditionally base on race and to some extent age. However, it is unclear which approach offers the best blood pressure control. The main goal of this article is to review and explore therapeutic interventions in the management of uncontrol hypertension in African-Americans utilizing ACE inhibitors and calcium channel blocker combination therapy.


A PubMed literature search was conducted with search terms hypertension,

uncontrol hypertension, African-Americans, hypertension management, ACE inhibitors, calcium

channel blockers, hypertension therapeutics, risk factors of hypertension. An additional search

was conducted in the American Journal of Hypertension and Cleveland Clinic Journal of

Medicine. Seven relevant articles were retrieved from PubMed, five from the American Journal

of Hypertension and four from the Cleveland Clinic Journal of Medicine and served as the basis

for the clinical review for this article. Additionally, data from the Pharmacogenomic

Antihypertensives agents in African Americans with Uncontrolled Hypertension

Evaluation of Antihypertensive Responses study to determine the effectiveness of

antihypertensives control rates in Africans Americans was utilized.1,2


The prevalence of hypertension is greater in African Americans with a higher incidence

of cardiovascular, cerebrovascular, end-stage kidney diseases and heart failures and associated

morbidities and mortalities. Traditionally, the initiation of antihypertensives is based on race and

age and recently discovered plasma renin activity.1 Conventional monotherapy and combination

therapy with calcium channel blocker and or diuretics may not be effective in African Americans

with uncontrolled blood pressure. Initiation of ACE inhibitors and calcium channel blockers

could potentially control blood pressure in African Americans. More evidence base study is

needed in the future to explore treatment modalities.


African-Americans have a greater burden of uncontrolled hypertension with higher prevalence,

morbidity, and mortality. Dietary and lifestyle modifications are essential in the initial

management. However, initiating ACE inhibitors and calcium channel blocker combination

therapy in African Americans with uncontrol hypertension are promising than conventional

calcium channel blocker monotherapy. ACE inhibitor and calcium channel blocker combination

therapy may be more effective than calcium channel blocker and diuretic combination therapy.

Further studies are needed to substantiate this study.


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