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.
Bonsu E. In African Americans with uncontrolled Hypertension, would the addition of ACE Inhibitors combination therapy be more effective than Calcium Channel Blocker monotherapy to control blood pressure?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2019; 1(4).
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