Shulman N B
J Natl Med Assoc. 1988 Mar;80(3):265-72.
The prevalence of hypertension and the incidence of complications from uncontrolled elevated blood pressure in blacks is much greater than in the white population. In general, blacks have underlying differences in the factors relating to blood pressure level, including low plasma renin, and, in certain instances, a decreased ability to excrete sodium. The stepped-care approach in the management of the black hypertensive patient is similar to that taken with white patients, but racial differences in response to antihypertensive drugs exist that require careful consideration when choosing a treatment regimen. Thiazide diuretics are effective in blacks and are often used as initial therapy. Blacks tend to respond less well to β-blockers, but when combined with a diuretic, they are also effective. Encouraging data are available on the use of calcium channel blockers in blacks. When combined with a diuretic, the angiotensin-converting enzyme (ACE) inhibitors also provide an alternative to therapy for black patients. The use of low doses of ACE inhibitors has reduced the high incidence of adverse effects associated with this group of drugs in earlier studies.
黑人高血压的患病率以及血压控制不佳导致并发症的发生率远高于白人。总体而言，黑人在与血压水平相关的因素上存在潜在差异，包括血浆肾素水平低，并且在某些情况下，排钠能力下降。黑人高血压患者的分级治疗方法与白人患者相似，但在对抗高血压药物的反应方面存在种族差异，这在选择治疗方案时需要仔细考虑。噻嗪类利尿剂对黑人有效，常被用作初始治疗。黑人对β受体阻滞剂的反应往往较差，但与利尿剂联合使用时也有效。关于黑人使用钙通道阻滞剂有令人鼓舞的数据。当与利尿剂联合使用时，血管紧张素转换酶（ACE）抑制剂也为黑人患者提供了一种治疗选择。在早期研究中，使用低剂量的ACE抑制剂降低了与这类药物相关的高不良反应发生率。
