ISHIB releases new recommendations to manage hypertension in African Americans

Through the publication of its Consensus Statement on the Management of High Blood Pressure in Blacks in this week's issue of Hypertension, ISHIB today released new recommendations recognizing that high blood pressure among African Americans is a severe health problem. The consensus statement suggests that treatment should start sooner and be more aggressive among African Americans.

The recommended hypertension management strategies, also recognized by the American Society on Hypertension, will assist physicians in ensuring optimal treatment for African Americans with, or at-risk of, high blood pressure.

After an extensive review of the most recent studies and other guidelines on the hypertension, the ISHIB writing group, led by John M. Flack, MD, MPH developed a step-by-step guide for risk-stratification, selecting blood pressure targets, and choosing drug treatments to reach these targets. The Consensus Statement offers charts with multi-drug combinations to give physicians tiered options for keeping blood pressure under control and optimally protecting target organs.

The consensus statement identifies two risk groups for Blacks with hypertension: primary prevention where blood pressure levels of <135/85 mm Hg are optimal and secondary prevention where achieving blood pressure levels <130/80 mm Hg is recommended. Patients who are candidates for the primary prevention group are those without target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease. Patients considered for the secondary prevention group have target organ damage, preclinical cardiovascular disease, and/or a history of cardiovascular disease.

"For patients in the primary prevention group, if blood pressure is above target (<145/90 mm Hg) by less than or equal to 10 mm Hg, we recommend monotherapy with a diuretic or calcium channel blocker; these agents give the greatest likelihood of blood pressure control with a single drug molecule," commented Dr. Flack, chairman of the department of medicine at Wayne State University in Detroit. "When blood pressure is above target by more than 15/10 mm Hg, we recommend the use of two-drug therapy, with either a calcium channel blocker plus a renin-angiotensin system blocker or, alternatively in those with edematous and/or volume overload states, with a thiazide diuretic plus a renin-angiotensin system blocker."

"We believe that these recommendations will lead to better blood pressure control, and a better outlook for African Americans with high blood pressure," Flack said.

According to the American Society of Hypertension, "the Consensus Statement on the Management of High Blood Pressure in Blacks provides an updated approach for treating hypertension in Blacks and integrates new data with opinion regarding how implementation should proceed. The Report and accompanying editorial commentary contributes to the dialogue critically important for clinicians and researchers to achieve an approach that takes both the patient and the data from trials into account."

For healthy African Americans, ISHIB also recommends that doctors suggest lifestyle changes to keep blood pressure levels at or below 115/75 mm Hg. Blood pressure below 120/80 is considered normal for healthy US adults.

"Epidemiological data show that 115/75 is the critical blood pressure number for adults, and every time that figure goes up by 20/10 the risk of cardiovascular disease essentially doubles. We think it makes perfect sense to start lifestyle changes at that lower threshold," Flack said. "The natural history of blood pressure is that it continues to go up as a person ages. In fact, from the age of 50 and onward, normotensive Americans have a 90 percent chance of ultimately developing hypertension."