Controlling hypertension in blacks needs early intervention, group says

Lowering target blood pressure levels for blacks and starting hypertension treatment earlier might improve health outcomes for such patients, according to new recommendations issued by the International Society on Hypertension in Blacks.

The consensus statement was published online Oct. 4 in the American Heart Assn.'s journal, Hypertension. The recommendations were updated from a 2003 statement by the nonprofit, Georgia-based medical organization.

"We feel that enough [data had been published] ... to adjust our recommendations for controlling blood pressure and reaching the target protection" for black patients, said John M. Flack, MD, MPH, lead author of the statement.

About one in three Americans 20 and older had hypertension in 2006, according to recent data from the AHA. Blacks develop the condition more often and at an earlier age than do whites and Mexican-Americans, said the Centers for Disease Control and Prevention.

The AHA considers blood pressure below 120/80 mmHg normal for healthy adults. The new recommendations, however, encourage physicians to begin counseling all black patients on lifestyle modifications when their blood pressure reaches or exceeds 115/75 mmHg (link). At that level, risks of hypertension-related conditions begin increasing among blacks, said Dr. Flack, chair of the Dept. of Internal Medicine at Wayne State University School of Medicine in Detroit.

Suggested lifestyle modifications include weight loss, eating more fruits and vegetables, increasing physical activity, limiting alcohol consumption and eliminating tobacco use.

When blood pressure levels exceed 135/85 mmHg, physicians should begin using medication to treat black patients who do not have cardiovascular disease or high blood pressure-related organ damage, the statement said.

Medical treatment should begin even earlier (when levels exceed 130/80 mmHg) for black patients who have health complications, including cardiovascular disease, diabetes, kidney disease or damage to organs such as the heart and kidneys. To achieve and maintain blood pressure below target levels, multiple antihypertensive medications will be required in most hypertensive blacks, according to the consensus statement.

An editorial published online Hypertension said some of the new recommendations are unsupported by clinical data. But Sidney C. Smith Jr., MD, an AHA spokesman, stressed that the recommendations are not official guidelines. He said physicians should view the consensus statement as helpful information on the increased risk of high blood pressure in blacks.

"You can quibble about what a target level should be for treatment. But there is no disagreement that we need to do a better job in identifying high blood pressure, especially in blacks, and in treating high blood pressure, especially in black men," said Dr. Smith, professor of medicine at the University of North Carolina at Chapel Hill School of Medicine.