Treat black patients more aggressively says International Society on Hypertension in Blacks

Because high blood pressure is such a serious health problem for black patients, the International Society on Hypertension in Blacks (ISHIB) is calling for earlier and more aggressive intervention for the black community.

High blood pressure tends to cause serious complications such as stroke, heart failure and kidney damage much more often among black patients than among whites, the organization noted.

On Monday, ISHIB issued a consensus statement with two main updates to its earlier recommendations: lowering the threshold at which black patients would start treatment, and moving rapidly from a single-drug therapy to a multi-drug therapy if necessary.

"Evidence from several recently completed studies converged to convince our committee that we were waiting a little bit too long to start treating hypertension in African Americans," lead author Dr. John M. Flack, chairman of the department of internal medicine at Wayne State University in Detroit, said in a news release from the American Heart Association.

For U.S. adults, blood pressure is considered normal when it is below 120/80. That figure references both the pressure in the arteries when the heart beats (top number) and the pressure when the heart relaxes between beats (bottom number).

However, ISHIB suggests that health providers should counsel healthy black patients to make lifestyle changes as soon as their blood pressure is 115/75 or higher. Such changes would include lowering salt intake, upping potassium intake by eating more fruits and vegetables, drinking in moderation, getting more aerobic exercise and losing weight if necessary.

Similarly, the organization said that although the general threshold for starting drug treatment among healthy patients is a blood pressure of 140/90, black Americans with no history of heart disease, diabetes or organ damage should commence drug treatment to lower blood pressure when their readings reach 135/85.

For black patients who do have a history of related health complications -- such as cardiovascular disease, diabetes, kidney disease or damage to target organs such as the heart, kidneys or brain -- the organization recommends that treatment begin as soon as their blood pressure is at or above 130/80.

And if a single-drug approach doesn't cause blood pressure to drop quickly, doctors should be prepared to swiftly embrace a multi-drug approach, the organization urged.

"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.

"The majority of patients of any race, and certainly African Americans, are going to need more than one drug to be consistently controlled below their goal," he added. "The debate in the medical community over which single drug is best overwhelms the most pressing question: Which drugs work best together?"

To that end, ISHIB is releasing a combination-drug chart that outlines what the organization believes to be the best multi-drug options, based on a review of the most recent research.

Flack and his colleagues present their current recommendations -- an update of ISHIB's 2003 consensus statement on blood pressure -- in the current edition of Hypertension: Journal of the American Heart Association.

Source: Bloomberg