Maryland Heart Center

African-Americans and Hypertension: A Q&A with UM Cardiologist Elijah Saunders

Elijah Saunders, M.D.

University of Maryland Medical Center cardiologist Elijah Saunders, M.D., recently held a press conference to discuss newly recommended guidelines for treating African Americans with hypertension.

The recommendations, published in the March 10 edition of the Archives of Internal Medicine, were created by the International Society on Hypertension in Blacks, an organization co-founded by Saunders.

Saunders, who's also a professor at the University of Maryland School of Medicine, answers questions about the need for the new guidelines.

Could you quantify the problem of hypertension among African-Americans?

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One African-American dies as a result of high blood pressure every hour in this country, which is nearly twice as often as their white counterparts. Blacks suffer from heart and kidney disease at alarmingly high rates, both of which are adversely affected by high blood pressure. In fact, blacks make up about 30 percent of those on dialysis due to kidney failure.

Blacks also develop high blood pressure at younger ages than whites and suffer more damage to their organs as a result of the disease.

What is the current standard of care for treating patients with high blood pressure?

Back in 1997, the National Heart, Lung, and Blood Institute drafted guidelines for treating hypertension that listed 140/90 mm Hg as the goal for lowering blood pressure in most patients.

Why does the International Society on Hypertension in Blacks think the National Heart, Lung, and Blood Institute's guidelines need to be modified for African-Americans?

Just under a quarter of all African-Americans with hypertension have the disease under control. We feel that the best approach to treatment is an aggressive one. We don't think that the NIH guidelines are adequate for treating African-Americans.

How do the new guidelines differ from the National Heart, Lung, and Blood Institute's guidelines?

First of all, we recommend that all African-American patients with hypertension aim to lower their pressure to 130/80 mm Hg, not the currently accepted 140/90 mm Hg, particularly when they have other conditions such as diabetes, kidney or heart disease.

We also urge doctors to start out treating African-American patients with at least two medications instead of just one. One of these medications should include a diuretic since African-Americans are especially sensitive to salt and tend to retain salt.

Also as part of the combination drug therapy, patients with diabetes and kidney disease should be given ACE inhibitors and angiotensin II receptor blockers. Even though studies have shown that these medications don't necessarily lower blood pressure, they have been shown to slow the progression of kidney disease.

Are there any other ways to lower blood pressure besides taking medication for it?

Yes, every patient, black or white, should be encouraged to make changes in their lifestyles. This is especially true among African-American patients because there is so much obesity and diabetes in the black community. That is why we have emphasized the Dietary Approaches to Stop Hypertension or DASH diet.

Studies have shown that blacks who follow this diet, which is rich in fruits, vegetables and fiber, have been able to successfully lose weight and control their blood pressure.

Do you think that by treating high blood pressure more aggressively that the incidence of co-related diseases such as heart and kidney disease will decrease?

Yes, we think that bringing down blood pressures will translate into less morbidity and mortality from other diseases.

Are there any symptoms associated with hypertension? How does a person know they have it?

No, there really arent any symptoms, and that is why it is so important for patients to get their blood pressure checked regularly. Even though patients rarely experience any symptoms with hypertension, they do report feeling a lot better, in general, once they get their blood pressure under control.

Is there any way to control high blood pressure without medication? Can a person who has been successful in bringing their blood pressure down stop taking their medication?

No. A person can take less medication once they have their pressure under control, but they would still have to take some medication.

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