Ferdinand Keith C
Emory University and the Association of Black Cardiologists, Atlanta, GA 30349, USA.
J Clin Hypertens (Greenwich). 2008 May;10(5):382-9. doi: 10.1111/j.1751-7176.2008.07918.x.
Blacks have the highest rates of hypertension and cardiovascular disease, with earlier onset, greater severity, and more target organ damage including coronary disease, heart failure, stroke, and end-stage renal disease. A major reason is the greater prevalence of other cardiovascular disease risk factors, particularly obesity, inactivity, and diabetes mellitus, along with socioeconomic differences, adherence, and achievement of goals. This review focuses on the burden of cardiovascular disease in blacks. Therapeutic lifestyle changes and pharmacologic interventions to decrease clinical events in this high-risk group are described. Intensive blood pressure control is a primary means of "stopping the clock" in the progression of cardiovascular disease and renal disease. Thiazide diuretics remain primary first-step agents, especially for uncomplicated hypertension; calcium channel blockers are also efficacious. However, renin-angiotensin system modulators may also be beneficial, especially with a diuretic, considering the high prevalence in this group of patients of compelling indications for use of such agents.
黑人患高血压和心血管疾病的比例最高，发病更早，病情更严重，且有更多的靶器官损害，包括冠状动脉疾病、心力衰竭、中风和终末期肾病。一个主要原因是其他心血管疾病风险因素的患病率更高，尤其是肥胖、缺乏运动和糖尿病，以及社会经济差异、依从性和目标达成情况。本综述重点关注黑人的心血管疾病负担。描述了为降低这一高危人群临床事件而进行的治疗性生活方式改变和药物干预。强化血压控制是在心血管疾病和肾脏疾病进展过程中“延缓病程”的主要手段。噻嗪类利尿剂仍然是主要的一线药物，特别是对于单纯性高血压；钙通道阻滞剂也有效。然而，考虑到该组患者中使用此类药物有明确指征的患病率较高，肾素-血管紧张素系统调节剂可能也有益处，尤其是与利尿剂联合使用时。
