Tailoring antihypertensive drug therapy for the black patient.

Blacks experience greater incidence, morbidity, and mortality from hypertension in comparison with whites. Blacks also respond differently to antihypertensive agents. While whites tend to respond in similar fashion to many of the different classes of antihypertensives, blacks consistently have the best response to thiazide diuretics. When a second drug is needed for blood pressure control, there are a number of choices: a beta-blocker, an alpha-beta blocker, an alphablocker, a centrally acting agent, a peripherally acting agent, an angiotensin-converting enzyme (ACE) inhibitor, or a calcium channel blocker. Choosing among these involves considerations of efficacy, likelihood of compliance, and symptomatic and metabolic side effects-all important factors. Clinical experience with the ACE inhibitors, and captopril in particular, has shown the value of adding such a drug to a diuretic regimen, both in terms of controlling blood pressure and reducing metabolic derangements, and subsequently, cardiovascular risk factors. Labetalol, the alpha-beta blocker, and prazosin, the alphablocker, have also produced good results in some studies when combined with a thiazide in black patients.