Pathophysiologic and pharmacotherapy considerations in the management of the black hypertensive patient.

The mortality and morbidity of hypertension-related diseases among blacks are much higher than in age- and sex-matched white counterparts. New data show that the incidence of renal damage may be 18 to 20 times greater in blacks than in whites. Some preliminary data also indicate that coronary heart disease is much more prevalent in blacks than previously suspected and that coronary heart disease mortality among blacks may indeed not be declining, as it is for white populations. Major contributors to these findings in blacks are an increased prevalence and severity of hypertension, a possibly increased susceptibility to end-organ damage, socioeconomic factors and beliefs that affect hypertension control, and very possibly some obsolete treatments that focus on blood pressure numbers and do not emphasize the black person and the associated risk factors. Diuretic therapy has long been the mainstay treatment for black hypertensives, but the effects of diuretics on lipid levels and left ventricular hypertrophy, among other factors, should be carefully assessed. A recent study of beta-blockers in blacks showed that metoprolol was effective and well tolerated. Consideration of epidemiologic, pathophysiologic, and pharmacotherapeutic features of hypertension in blacks may require traditional views of this disease and its treatment in this special population to be reevaluated.