https://acpinternist.org/weekly/archives/2010/10/12/2.htm

Updated consensus statement issued for hypertension management in blacks

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An updated consensus statement on management of hypertension in blacks was issued last week, focusing on primary and secondary prevention.

The International Society on Hypertension in Blacks released its first consensus statement on this topic in 2003. Available data from subsequent clinical trials prompted the update. The authors reviewed existing guidelines on prevention and treatment of hypertension and cardiovascular disease, hypertension trials that reported clinical end points, and trials that looked at lowering blood pressure in blacks. Studies that included other ethnic groups were also considered. The statement divided blacks with hypertension into two groups according to risk: primary prevention (defined as those with high blood pressure but no target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease) and secondary prevention (defined as high blood pressure with target organ damage, preclinical cardiovascular disease, and/or a history of cardiovascular disease). The consensus statement was published online Oct. 4 by Hypertension.

The statement's recommendations include the following:

  • For primary prevention, a target blood pressure <135/85 mm Hg is recommended.For secondary prevention, a target blood pressure <130/80 mm Hg is recommended.Patients whose blood pressure is >10 mm Hg above target should receive monotherapy with a diuretic or calcium-channel blocker.Patients whose blood pressure is >15/10 mmHg above target should receive two-drug therapy with a calcium-channel blocker and a renin-angiotensin system blocker or, in cases of edema or volume overload, a thiazide diuretic plus a renin-angiotensin system blocker.Lifestyle modifications should be attempted when blood pressure is >115/75 mm Hg.

An accompanying editorial said the statement offered “useful, practical information to guide practitioners in the diagnosis, prevention, and treatment of hypertension in black patients.” However, the editorialists questioned the strong recommendation for a calcium-channel blocker and a renin-angiotensin system blocker over other types of two-drug therapy, noting that it is based on data from only one trial. They also questioned the evidence for recommending lower blood pressure targets. “Rather than setting new lower [blood pressure] goals, we suggest a greater focus on increasing the number of patients controlled to the conventional goal of <140/90 mm Hg,” they wrote.