Hypertension experts from across the U.S. are calling for more aggressive treatment of African-Americans with high blood pressure.
The recommendations are published in the March 10 edition of the Archives of Internal Medicine in the article, "Management of High Blood Pressure in African-Americans."
"We have compelling evidence that African-Americans are significantly more likely to die from the consequences of high blood pressure than the general public, and that may be because current treatment strategies have not been very successful," says Elijah Saunders, M.D., professor of medicine at the University of Maryland School of Medicine and cardiologist at the University of Maryland Medical Center.
The recommendations urge health care providers to manage high blood pressure in African-Americans in three new ways:
The recommendations are spearheaded by the International Society on Hypertension in Blacks (ISHIB), a group co-founded by Dr. Saunders in 1986. They are endorsed by some of the nation's leading health organizations: the American Heart Association, the Association of Black Cardiologists, the Consortium for Southeastern Hypertension Control and the National Medical Association.
"On average, one African-American dies from high blood pressure every hour, yet barely a quarter of hypertensive African-Americans has the disease under control," says John Flack, M.D., president of ISHIB and chief quality officer at Wayne State University in Detroit, Mich. "ISHIB developed these recommendations -- with the participation of the nation's most prominent high blood pressure experts -- to give health care providers the tools to manage high blood pressure appropriately in African-Americans and save lives."
Nearly 40 percent of African-Americans suffer from heart disease and 13 percent have diabetes. Thirty-two percent of people on dialysis due to kidney failure are African- American. Because high blood pressure contributes to all of these conditions or makes them worse, the panel is urging health care providers to act more aggressively to lower the blood pressure of patients with these disorders -- especially those with diabetes and/or kidney disease -- to less than 130/80 mm Hg. This is a significant change from the previous standard of 140/90 mm Hg (for most patients) and 130/85 mm Hg (for those with diabetes) recommended in 1997 by National Institutes of Health guidelines.
Numerous clinical studies, including the recently completed Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), demonstrate that many African-American patients will require two or more medications (one of which is most often a diuretic) to reach target blood pressure goals and reduce their risk of heart attacks, strokes and kidney disease.
The panel recommends that health care providers and patients follow the "15-over-10 rule." This means that any patient with a systolic (upper number) blood pressure greater than or equal to 15 mm Hg and a diastolic (lower number) blood pressure greater than or equal to 10 mm Hg above the desired goal should start on two medications instead of one. For example, a patient (without diabetes, kidney or heart disease) whose target is less than 140/90 mm Hg, but who has a blood pressure of 155/100 mm Hg or greater, would be a candidate for combination therapy.
The panel also recommends that health care providers urge their patients to exercise, lose weight (if overweight), moderate their alcohol intake and avoid tobacco. In addition, the panel has endorsed the Dietary Approaches to Stop Hypertension (DASH) diet. In carefully conducted clinical studies, this diet was shown to lower blood pressure significantly, especially in African Americans. The DASH diet is rich in fruits, vegetables and fiber. It also emphasizes the consumption of low-fat dairy foods, less meat and more poultry, and recommends high potassium and low sodium (salt) intake.
"By assessing patients' risk for heart and kidney disease, encouraging patients to follow the DASH diet and prescribing a combination of medications to get to the recommended blood pressure level, we believe we can make a significant difference. Our hope is that these recommendations will help health care providers save the lives of thousands of African-Americans with high blood pressure," says Dr. Saunders.
The initiative was supported, in part, by an unrestricted educational grant from Novartis Pharmaceuticals Corporation.
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