Race and Anti-Hypertensive Medications Hypertension

Race and Anti-Hypertensive Medications

Hypertension is a prevalent cardiovascular condition among American adults, with one third of adults in the United States being afflicted (Ferdinand & Saunders, 2006). The prevalence of hypertension varies across racial groups, with African-Americans being the most disproportionately affected in comparison to Mexican-Americans and non-Hispanic whites (Ferdinand & Saunders, 2006). In general, African-Americans experience a shorter life expectancy than whit Americans, and this may be due to the greater organ damage experienced by this population as a result of earlier onset of high blood pressure and high severity of hypertension among this population (Ferdinand & Saunders, 2006). Due to the greater prevalence of hypertension among the African-American population, it is crucial that attention be paid to treatments and preventions that are most optimal for this population.

Research has indicated that certain anti-hypertensive medications work more effectively with African-Americans than other medications. For instance when administered alone, calcium channel blockers and diuretics have been demonstrated as more effective in lowering blood pressure in African-Americans than angiotensin-converting enzyme inhibitors (ACE inhibitors), beta blockers, and angiotensin II receptor blockers (Ferdinand & Saunders, 2006). However, evidence has demonstrated that when combined with a diuretic, all off these treatments are as effective with African-Americans as they are with other racial groups. Therefore, combination therapy is often recommended as the most effective mode of treatment for African-Americans with hypertension, especially those experiencing comorbid renal disease and diabetes, which are common among this population (Ferdinand & Saunders, 2006). The prevalence of these comorbidities and hypertension in general among the African-American population has indicated the potential need for the development of a single dose treatment that contains more than one therapeutic agent (Ferdinand & Saunders, 2006).

There are distinct similarities between African-Americans and individuals with diabetes as hypertensive populations that are difficult to treat (Flack & Hamaty, 1999). These similarities include high prevalence of hypertension, high levels of target-organ damage that is related to high blood pressure, and the existence of reduced natriuretic capacity, which contributes to reduced effectiveness of single-agent anti-hypertensive drug therapies among this population (Flack & Hamaty, 1999). Most single anti-hypertensive medications or effective in controlling blood pressure in only 50-60% of patients, and this effectiveness rating greatly declines among individuals with stage 3 hypertension and renal insufficiency, which is common among both African-Americans and those with diabetes (Flack & Hamaty, 1999).

Furthermore, hypertension is experienced more frequently and more severely among African-Americans than in other racial populations, which inevitably has led to greater morbidity and mortality among this population (Brewster, van Montfrans, Kleijnen, 2004). Brewster, van Montfrans, and Kleijnen (2004) systematically reviewed the effectiveness of various antihypertensive drugs in the reduction of blood pressure, morbidity, and mortality among African-American adults with hypertension. Their investigation was conducted through a search of medical research databases, including MEDLINE, EMBASE, LILACS, PubMed, African Index Medicus, and the Cochrane Library. The results yielded from this investigation indicated that the effectiveness of beta-blockers and ACE inhibitors in reducing hypertension did not differ significantly from effects of a placebo. Other reviewed drugs such as calcium channel blockers, diuretics, central sympatholtics, alpha-blockers, and angiotensin II receptor blockers were demonstrated as more effective than placebos in reducing hypertension among African-Americans. However, this investigation demonstrated that there were no significant differences in morbidity and mortality outcomes between treatment groups (Brewster et al., 2004).

Further evidence in support of the idea that certain anti-hypertensive medications are more or less effective among African-Americans was established by Menon, Berezny, Kilaru, Benjamin, Kay, Hazan, Portman, Hogg, Deitchman, Califf. And Li, (2006). These researchers took previous findings regarding the efficacy of ACE inhibitors (Fosinopril, in particular) and applied them to children of different racial populations. Moreover, Menon et al. (2006) investigated whether the evidenced differences in effectiveness of ACE inhibitors among adults of different racial groups transferred to children of different racial groups. The results of the study indicated that Fosinopril was effective in treating hypertension in all racial groups, but Black children in the study required a higher dosage of the anti-hypertensive medication in order to experience the beneficial results. Furthermore, the differences in ACE inhibitor efficacy observed among adults of different races exist also in children of various races (Menon et al., 2006).

The demonstrated fact that African-Americans with hypertension are not as responsive to certain anti-hypertensive medications than non-African-Americans has opened the door for further research. Papademetriou, Narayan, and Kokkinos (2004) studied the effectiveness of ACE inhibitors in relation to angiotensin receptor blockers and the extent of cross-resistance to these anti-hypertensive agents among African-Americans. Results indicated that approximately equal proportions of the population under study responded favorably to each type of medication, while only a small proportion (14%) responded to both types of medication and a rather large proportion (48%) were non-responsive to either medication (Papademetriou et al., 2004).