The management of hypertension in African Americans.
The management of hypertension in African Americans.
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DOI：
10.1097/hpc.0b013e318053da59
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发表时间：
2007-06-01
影响因子：
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通讯作者：
Armani, Annemarie M
中科院分区：
文献类型：
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作者：
Ferdinand, Keith C;Armani, Annemarie M
美国黑人的高血压患病率位居世界前列。与白人相比，黑人患高血压的年龄更早，他们的平均血压要高得多，疾病的严重性也更严重。因此，黑人的非致命性中风的发病率是白人的1.3倍，致命中风的发病率是白人的1.8倍，心脏病死亡率是白人的1.5倍，终末期肾病的发病率是黑人的4.2倍，心力衰竭的发病率是白人的50%。总体而言，非裔美国人死于高血压及其后果的可能性是白人的4至5倍。高血压和过度靶器官损害的患病率增加是遗传因素和环境因素共同作用的结果。目前没有临床试验数据表明，应该为非洲裔美国人等高危人群设定低于正常水平的BP目标。预防和早期治疗非裔美国人高血压的主要手段将是适当地使用改变生活方式。国际黑人高血压协会的指南意识到，大多数患者将需要联合治疗，其中许多是一线治疗，以达到适当的血压目标。尽管某些类别和组合的抗高血压药物已经被证实是有效的，但非洲裔美国人患者联合治疗的药物选择可能会有所不同。在非裔美国人群体中，对血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和β受体阻滞剂单一治疗的反应性可能低于利尿剂和钙通道阻滞剂，但当利尿剂添加到神经激素拮抗剂中时，这些差异被纠正。值得注意的是，非裔美国人的收缩压15毫米汞柱或舒张压10毫米汞高于目标值的患者应该接受一线联合治疗。
The prevalence of hypertension in blacks in the United States is among the highest in the world. Compared with whites, blacks develop hypertension at an earlier age, their average blood pressures are much higher and they experience worse disease severity. Consequently, blacks have a 1.3 times greater rate of nonfatal stroke, 1.8 times greater rate of fatal stroke, 1.5 times greater rate of heart disease death, 4.2 times greater rate of end-stage kidney disease, and a 50% higher frequency of heart failure; overall, mortality due to hypertension and its consequences is 4 to 5 times more likely in African Americans than in whites. The increased prevalence of hypertension and excessive target organ damage is due to a combination of genetic and, most likely, environmental factors. There are no clinical trial data at present to suggest that lower-than-usual BP targets should be set for high-risk demographic groups such as African Americans. The primary means of prevention and early treatment of hypertension in African Americans will be the appropriate use of lifestyle modification. The International Society of Hypertension in Blacks guidelines realize that most patients will require combination therapy, many of them first-line, to reach appropriate BP goals. Although certain classes and combinations of antihypertensive agents have been well-established to be effective, the choice of drugs for combination therapy in African American patients may be different. Within the African American group, the responsiveness to monotherapy with ACE inhibitors, angiotensin receptor blockers, and beta blockers may be less than the responsiveness to diuretics and calcium channel blockers, but these differences are corrected when diuretics are added to the neurohormonal antagonists. Of note, African American patients with systolic BP >15 mm Hg or a diastolic BP >10 mm Hg above goal should be treated with first-line combination therapy.