what treatment is most effective for treating hypertension in hispanic males

National recommendations suggest that diuretics be the agents of first choice when treating this hypertension. For African Americans, a special ethnic group in terms of cardiovascular risk, CCBs may be added to diuretics as additional therapy. The JNC VI has no specific recommendations for Latinos.

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How can we prevent hypertension in Hispanics?

Dec 12, 2012 · This article discusses ethnic differences in BP and cardiovascular risk factors, reviews the literature on the efficacy of antihypertensive agents in Hispanic patients, and describes the role of renin-angiotensin-aldosterone system (RAAS) inhibitors, including direct renin inhibitors (DRIs), in the treatment of Hispanic patients with hypertension.

How effective is combination therapy for hypertension (high blood pressure) in Hispanic patients?

Pharmacologic therapies for hypertension have been highly effective in Hispanic subjects participating in clinical trials. Notably, studies that disaggregate Hispanics by their ancestral origin may provide greater insight into the sources of ethnic disparities.

What is the treatment of mild hypertension?

Sep 10, 2007 · The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) was a large, double-blind, randomized, active-controlled, practice-based trial in which 16% of the participants were Hispanic, and 35% of the participants were black. 9,10 The overall purpose of ALLHAT was to determine whether an angiotensin-converting enzyme inhibitor, a …

Is hypertension more common in Hispanic patients?

Compared to non-Hispanic Whites, Hispanic individuals have significantly lower levels of hypertension awareness, treatment, and control. This article provides an integrative review of factors that may influence self-management of hypertension among Hispanic adults. A detailed literature search of articles published between 1985 and 2010 was ...

What is the most effective treatment for hypertension?

What are 3 treatments for hypertension?

What therapy does current research show do you be most effective in treating hypertension in people over the age of 55?

What is the best first line treatment for hypertension?

What is the latest treatment for high blood pressure?

What are the main classes of drug used to treat hypertension?

What is the best strategy for management of hypertension in the elderly?

How is hypertension treated in the elderly?

How is hypertension treated in elderly?

Which are the drugs for 2nd line treatment of hypertension?

What is the second drug of choice for hypertension?

Why are culturally tailored interventions important for Hispanics?

Culturally tailored interventions may improve hypertension management and outcomes in Hispanic populations.

Do Hispanics have suboptimal hypertension?

Substantial variation in hypertension prevalence and control exists among different ethnic subgroups of Hispanics. More specifically, and in the community, outcomes for hypertension management are less favorable, suggesting that suboptimal hypertension control may be the result of social factors. In …

Why is BP control better in Allhat?

An alternative explanation for better BP control in ALLHAT Hispanic participants could be that they differed systematically from non-Hispanic participants in ways not measured in ALLHAT. For example, although ≈90% of Hispanics reported treatment at baseline, actual adherence to medication may have been lower, as reflected in the slightly higher baseline BP levels. Because treatment at baseline was inversely associated with the likelihood of achieving BP control in ALLHAT, 11 if more Hispanic participants were actually untreated, this might explain why they achieved better BP control on fewer drugs.

What group had the highest baseline SBP?

Although a similar proportion (≈90%) of each group reported being treated with antihypertensive medication at baseline ( Table 1 ), Hispanic blacks had the highest baseline SBP and DBP, followed by Hispanic whites ( Table 2 ). Non-Hispanic blacks and whites had similar SBP, but non-Hispanic whites had lower DBP. Within 6 months of follow-up, Hispanic whites had the lowest SBP, followed by Hispanic blacks and non-Hispanic whites. Non-Hispanic blacks had the highest SBP. Hispanics had DBP intermediate between non-Hispanic whites and blacks. These patterns were generally consistent through 4 years of follow-up. At all of the time points, compared with non-Hispanics, Hispanics were treated with a lower mean number of antihypertensive medications (1.4 vs 1.8 at 4 years).

Is BP control in Hispanics a priority?

ALLHAT provided a large population in which to study hypertension treatment in Hispanics. The evidence is clear: BP control in Hispanic patients is an achievable goal and should therefore be declared a public health priority.

Do Hispanics have blood pressure control?

Historically, blood pressure control in Hispanics has been considerably less than that of non-Hispanic whites and blacks. We compared determinants of blood pressure control among Hispanic white, Hispanic black, non-Hispanic white, and non-Hispanic black participants (N=32 642) during follow-up in a randomized, practice-based, active-controlled trial. Hispanic blacks and whites represented 3% and 16% of the cohort, respectively; 33% were non-Hispanic black and 48% were non-Hispanic white. Hispanics were less likely to be controlled (<140/90 mm Hg) at enrollment, but within 6 to 12 months of follow-up, Hispanics had a greater proportion <140/90 mm Hg compared with non-Hispanics. At 4 years of follow-up, blood pressure was controlled in 72% of Hispanic whites, 69% of Hispanic blacks, 67% of non-Hispanic whites, and 59% of non-Hispanic blacks. Compared with non-Hispanic whites, Hispanic whites had a 20% greater odds of achieving BP control by 2 years of follow-up (odds ratio: 1.20; 95% CI: 1.10 to 1.31) after controlling for demographic variables and comorbidities, Hispanic blacks had a similar odds of achieving BP control (odds ratio: 1.04; 95% CI: 0.86 to 1.25), and non-Hispanic blacks had a 27% lower odds (odds ratio: 0.73; 95% CI: 0.69 to 0.78). We conclude that in all patients high levels of blood pressure control can be achieved with commonly available medications and that Hispanic ethnicity is not associated with inferior control in the setting of a clinical trial in which hypertensive patients had equal access to medical care, and medication was provided at no cost.

Do Hispanics have BP?

Hispanic ALLHAT participants were more likely than non-Hispanic participants to have uncontrolled BP at enrollment into the study. Although a similarly high proportion (90%) reported treatment with antihypertensive medications in all of the race/ethnic groups at entry, it is possible that the number of drugs, types of drugs, dosage, or adherence differed between Hispanics and non-Hispanics. Baseline data on these variables were not collected in ALLHAT. In population-based studies, such as NHANES, BP control rates in treated Mexican Americans have been consistently lower than in non-Hispanic white Americans for >2 decades. 1–5 In a multiethnic national sample of perimenopausal women, Hispanic women had the lowest rates of BP control (11%). 17 Other regional studies have reported similar results in Mexican Americans 18–20 and Puerto Ricans living in Massachusetts. 21 The only study that has directly compared different subgroups of Hispanic Americans was the 1982–1984 Hispanic Health and Nutrition Examination Survey. 22 This study showed very low rates of BP control (8% to 9%) among Mexican American, Cuban American, and Puerto Rican men, although BP control was higher in women (34% in Mexican Americans, 28% in Puerto Ricans, and 14% in Cuban Americans).

What is personalized management of HTN?

Personalized management of HTN has been an explicit goal dating back to Joint National Committee (JNC)I13. Personalized medicine strives for “treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations”14.

What is HTN in blacks?

Blacks are especially susceptible to hypertension(HTN) and its associated organ damage leading to adverse cardiovascular, cerebrovascular and renal outcomes. Accordingly, HTN is particularly significant in contributing to the black-white racial differences in health outcomes in the US. As such, in order to address these health disparities, practical clinical practice guidelines (CPGs) on how to treat HTN, specifically in blacks, are needed. This review article is a timely addition to the literature because the most recent U.S. CPG more explicitly emphasizes race into the algorithmic management of HTN. However, recent clinical research cautions that use of race as a proxy to determine therapeutic response to pharmaceutical agents may be erroneous. This review will address the implications of the use of race in the hypertension CPGs. We will review the rationale behind the introduction of race into the U.S. CPG and the level of evidence that was available to justify this introduction. Finally, we will conclude with practical considerations in the treatment of HTN in blacks.

What is the biological profile of HTN in blacks?

The most recognized biological profile associated with HTN in blacks is the low renin physiology18. This physiology is associated with a salt-sensitive phenotype with excess effective circulating volume being the mechanism of HTN. This finding has been used to lend credence to the current strategy of using specific anti-HTN classes in blacks that address volume issues [ie. dihydropyridine calcium channel blockers (DHP-CCB) and diuretics]. While it appears that blacks tend to have a higher prevalence of low renin physiology than other racial/ethnic groups, caution must be taken to avoid the presumption that the distribution of renin activity in blacks is limited to the lower activity levels18. Furthermore, it should be appreciated that the low renin physiology cited usually refers to systemic renin activity, which has been shown to be often discordant with tissue renin activity19, which is arguably more important in terms of organ damage (eg intra-renal renin activity). Therefore, even though BP lowering may not be as robust with the “anti-renin” drugs (ie ACEIs/ARBs/Beta-blockers), the tissue-protective benefits should certainly be considered in the treatment of blacks in an effort to not only improve BP control but to achieve the ultimate goal of reducing the risk of organ damage.

Do blacks get HTN?

Given that HTN disproportionately affects the black population in the US3, blacks have been relatively under-represented in US HTN trial s. Even though the earliest Veteran Administration Cooperative Studies4, 5enrolled a relatively high proportion of blacks (>40%), these were smaller scale trials that do not represent modern day HTN therapy. Since these earlier trials, the more contemporary HTN trials have enrolled lower proportions of blacks (< 20%)6–8. It was only with the enrollment of a substantial proportion of blacks (35%) in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) that the HTN guideline committees had good quality data on blacks with HTN with which to make recommendations/statements.

Is diuretic a first line agent?

Diuretics are recommended as first line agents in all hypertensives. JNC 7 mentions that diuretics are more effective at BP lowering in blacks than beta-blockers, ACE-I or ARBs. However, blacks with diseases such as chronic kidney disease and myocardial infarction benefit from ACE-I and beta-blockers. Consider the use of combination drug therapy that includes a thiazide type diuretic

Is mono therapy effective for blacks?

For whites, beta-blockers are also an option for first line therapy. Mono-therapy with beta-blockers or ACE-Is is less effective in blacks. More black patients will require multidrug therapy.

Can black people take diuretics?

In the text of the guideline, mentions that, with regard to mono-therapy, black hypertensive may respond more effectively to diuretics. Blacks tend not respond as well to beta-blockade or ACE-I as do whites. However, combinations of beta-blockers or ACE-I with diuretics are equally effective in black and white hypertensive patients. Similar BP lowering responses have been noticed with calcium channel blockers, centrally acting alpha-2 agonists, peripheral alpha-1 antagonists, and combined alpha/beta - blockers

Do Hispanics have a higher chance of controlling blood pressure?

With equal access to medical care and medication, Hispanic men and women have as good or greater chance as non-Hispanics of controlling their high blood pressure, researchers reported in Hypertension: Journal of the American Heart Association.

Do Hispanics have better blood pressure than non-Hispanics?

When researchers studied blood pressure control in Hispanics as part of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), they found that Hispanics responded as well or better than non-Hispanics.

What are some examples of ACE inhibitors?

There are several ACE inhibitors available. Examples include enalapril (Vasotec, Epaned), lisinopril (Prinivil, Zestril, Qbrelis) and ramipril (Altace). Angiotensin II receptor blockers (ARBs). These drugs block the action of angiotensin, a chemical in your body that narrows your arteries and veins.

What are some examples of beta blockers?

Examples of beta blockers include metoprolol (Lopressor, Toprol-XL), nadolol (Corgard) and atenolol (Tenormin). Renin inhibitors. Renin is a substance produced by your kidneys that triggers a series of steps that increases blood pressure.

What is the best medicine for a relaxed heart?

Alpha blockers. Alpha blockers prevent the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins, which causes the vessels to remain open and relaxed. Commonly prescribed alpha blockers include doxazosin (Cardura), prazosin (Minipress) and terazosin.

What are some examples of calcium channel blockers?

Examples of calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others), nifedipine (Adalat CC, Procardia) and verapamil (Verelan, Calan). Beta blockers. These drugs work by blocking the effects of the hormone epinephrine, also known as adrenaline.

What is the best medication to relax the arteries?

Calcium channel blockers. These medications prevent calcium from entering the cells of your heart and arteries, allowing your arteries to relax and open.

How to reduce sodium in your diet?

Eat a healthy diet with plenty of fruits and vegetables and reduce the amount of sodium in your diet.

How to control high blood pressure?

Try these lifestyle changes to help lower and control your blood pressure. Eat a healthy diet with plenty of fruits and vegetables and reduce the amount of sodium in your diet. ...

How many people have high blood pressure?

High blood pressure affects nearly 1 in 2 adults in the United States. 1 This condition, also known as the “silent killer,” increases your risk of heart disease and stroke.

When was the book Burden Data published?

Published in 2010, the book and executive summary consist of the following information: Burden data pertaining to African American men and high blood pressure. Effective and culturally appropriate promising practices and interventions. A list of men’s health informational resources.

Is high blood pressure more common in black people?

High blood pressure is more common in non-Hispanic Black adults (54%) than in non-Hispanic white adults (46%), non-Hispanic Asian adults (39%), or Hispanic adults (36%). 1 A heightened response is required due to the disparities in high blood pressure control in African American men. In order to provide a resource for public health programs, ...

What is the DBP for mild hypertension?

The Treatment of Mild Hypertension Study showed that treatment (with 1 of 5 different antihypertensive drug regimens) plus multifactorial lifestyle modification compared with multifactorial lifestyle modification alone in men and women aged 45 to 69 years (20% black) with diastolic BP (DBP) <100 mm Hg (baseline BP: 140/91 mm Hg) reduced the risk of the aggregate end point of pressure-related complications when SBP was lowered to ≈126 mm Hg (lifestyle modification plus active drug) versus ≈132 mm Hg (lifestyle modification alone). 132 Clinical event rates were 16.2% (lifestyle modification only) versus 11.1% (active drug treatment) ( P =0.03), and quality of life was also improved more in the active drug treatment group. The Cardio-Sis study, another prospective, randomized trial, was conducted in 1111 European nondiabetic men and women with SBP ≥150 mm Hg plus 1 additional CVD risk factor at entry to determine whether a target SBP <130 mm Hg (tight control) was superior to SBP <140 mm Hg (usual control). 133 After a median 2-year follow-up, the rate of ECG-LVH (primary end point) was 37% lower ( P =0.013) in the tight-control group compared with the usual-control group; the secondary composite CVD end point was also lower (9.4% versus 4.8%; P =0.003) in the tight-control group. The attained BP level at the end of 2-year follow-up was 131.9/74.0 in the tight-control group versus 135.6/78.7 mm Hg in the usual-control group (72.2% versus 27.3% achieved BP <130/80 mm Hg). 133 Pharmacological treatment of prehypertensive middle-aged (48.5 years) individuals in the Trial of Preventing Hypertension reduced the incidence of frank HTN by 66.3% ( P <0.001) at 2 years and by 15.6% ( P <0.007) at 4 years compared with placebo. 134 Finally, in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the best study outcomes overall were obtained with chlorthalidone, in which group BP averaged 134/76 mm Hg at 4.9-year follow-up. 135 Collectively, these studies suggest the likely benefits of pharmacological treatment of HTN in lower risk hypertensive patients to BP levels lower than those currently recommended by JNC 7 or other organizations. Thus, our new recommendation is to maintain BP persistently <135/85 mm Hg in patients who do not have evidence of target organ damage, preclinical CVD, or overt CVD. In such patients, if BP is <145/90 mm Hg in the absence of target-organ injury or other risk-enhancing comorbidities, ≤3 months of comprehensive lifestyle modification may be attempted without concurrent drug therapy (see Figure 1 ).

What is the appropriate blood pressure control in diabetes?

In the placebo-controlled Appropriate Blood Pressure Control in Diabetes normotensive study, 34 patients with type 2 diabetes mellitus and BP <140/90 mm Hg were randomized to moderate BP control (DBP : 80 to 89 mm Hg; placebo) or intensive BP control (DBP: 10 mm Hg lower than baseline; active drug therapy). Baseline BP averaged 137/84 and 136/84 mm Hg, respectively, in the 2 treatment groups. Over ≈5 years, there was less progression of retinopathy and proteinuria and fewer strokes in the intensive-control group (BP averaged 128/75 mm Hg) compared with the moderate-control group (BP averaged 137/81 mm Hg). 34 In the Appropriate Blood Pressure Control in Diabetes hypertensive study 33 in patients with type 2 diabetes mellitus and DBP ≥90 mm Hg who were randomized to either intensive BP control (DBP: <75 mm Hg) or moderate BP control (DBP: 80 to 89 mm Hg), fewer overall deaths (5.5% versus 10.7%; P =0.037) occurred in the intensive BP control group. In the Hypertension Optimal Treatment Study, 37 there were fewer CVD events and myocardial infarctions and lower CVD mortality in the diabetic subgroup randomized to the ≤80-mm Hg treatment arm compared with the ≤90-mm Hg treatment arm. Thus, the totality of evidence, including the absence of substantive harm from aggressive BP lowering, was persuasive enough to leave unchanged the goal BP (<130/80 mm Hg) for nephropathy-, retinopathy-, and stroke-prone blacks with diabetes mellitus and HTN.

What was the prevalence of HTN in 2006?

The age-adjusted prevalence of HTN during 2006 among individuals aged ≥20 years in the total US population was 33.3% (73 600 000). 49 Non-Hispanic blacks had the highest age-adjusted prevalence (44.4% men and 43.9% women), non-Hispanic whites an intermediate prevalence (34.1% men and 30.3% women), and Mexican Americans the lowest prevalence (23.1% men and 30.4% women). In a different analysis among children aged 8 to 17 years in 1999–2000, systolic BP (SBP) levels were 2.9 and 1.6 mm Hg higher in non-Hispanic black boys and girls, respectively, than in age-matched non-Hispanic whites, a finding attributable in part to an increased prevalence of overweight in black children. 50

What are the beliefs of black people with HTN?

Nonbiomedical beliefs appear to be relatively common among blacks with HTN. A study of 93 blacks with HTN subjected to open-ended interviews during routine ambulatory clinic visits found that 38% believed that HTN could be cured, 38% believed that taking antihypertensive medication lifelong was not necessary, and 23% thought that antihypertensive medications needed to be taken only when experiencing symptoms. 64 Clearly, these beliefs could negatively influence the likelihood that blacks with HTN will seek treatment and, once prescribed, adherence to treatment over the long term.

How long does it take to reduce BP?

We recommend gradual reductions of BP over several weeks (or longer) to target BP levels. Particular caution should be taken to avoid overly rapid BP lowering, which can precipitate target-organ ischemia/dysfunction, especially in patients with extensive vascular disease and/or CKD. Table 3 lists the CVD conditions and the relative preferences/avoidances for the various antihypertensive drug classes when these conditions are present.

When was the first document to focus primarily on HTN in blacks or in any black population?

Accordingly, in March of 2003, the ISHIB published a consensus statement on the “Management of High Blood Pressure in African American,” 1 the first such document to focus primarily on HTN in blacks or in any black population.

Which country has the highest HTN rate?

Although blacks have widely been perceived as having the highest HTN rates in the world, they do not. Adults in Germany, Finland, and Spain all have higher age-adjusted rates of HTN (BP ≥140/90 mm Hg or treatment with antihypertensive medication). 51 Cross-continental studies show an escalating gradient of HTN prevalence in black populations, being lowest in Africa, intermediate in the Caribbean, and highest in the urban Midwestern United States. 52 Data from within black and African populations show striking BP gradients (rural < urban) that predictably track directly with Western lifestyles. 53 Cooper et al 52 studied populations in rural Cameroon, urban Cameroon, and Chicago in 1995 and showed that the HTN rates in these locations were 15%, 19%, and 33%, respectively.