Jamerson K A
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor 48109-0356.
Clin Exp Hypertens. 1993 Nov;15(6):979-95. doi: 10.3109/10641969309037086.
The aim of this review is to compare the prevalence of complications and response to different treatment for hypertension in African and European Americans. African Americans when compared to European Americans respond less favorably to beta-blockers (BB's) and angiotensin converting enzyme inhibitors (ACEI's). Nevertheless the observed response of African Americans to ACEI's and BB's is significant and these agents are very effective in this subgroup. African American race is not a clinically significant predictor of poor response to any class of antihypertensive therapy and there is little justification to use racial profiling as a criterion for choice of medication. Evidence to restrict or defer usage of BB's and ACEI's in African Americans is lacking. The mortality from hypertensive heart disease, stroke, and the incidence of hypertensive renal disease is higher in African Americans which leads some investigators to postulate that hypertension in African Americans is intrinsically different from whites. They therefore search for a separate etiology and suggest specific approaches to treatment. Awareness of racial differences in hypertension outcomes evolved in the U.S. in an historical context that does not fully appreciate that race is often a surrogate for many social and economic factors that influence health status and health care delivery in the U.S. Poor outcomes in African Americans occur in many diseases including hypertension.
本综述的目的是比较非裔美国人和欧裔美国人高血压并发症的患病率以及对不同治疗方法的反应。与欧裔美国人相比，非裔美国人对β受体阻滞剂（BBs）和血管紧张素转换酶抑制剂（ACEIs）的反应较差。然而，非裔美国人对ACEIs和BBs的观察反应是显著的，这些药物在该亚组中非常有效。非裔美国人种族并非对任何一类抗高血压治疗反应不佳的临床显著预测因素，几乎没有理由将种族特征作为药物选择的标准。缺乏限制或推迟非裔美国人使用BBs和ACEIs的证据。非裔美国人中高血压性心脏病、中风的死亡率以及高血压肾病的发病率较高，这使得一些研究人员推测非裔美国人的高血压与白人本质上不同。因此，他们寻找单独的病因并提出具体的治疗方法。在美国，对高血压结局种族差异的认识是在一个历史背景下发展起来的，而这个背景并没有充分认识到种族往往是许多社会和经济因素的替代指标，这些因素影响着美国的健康状况和医疗服务提供。非裔美国人在包括高血压在内的许多疾病中都有不良结局。
