Lower BP goals set for blacks to manage hypertension

The updated International Society on Hypertension in Blacks (ISHIB) consensus statement on the management of hypertension in this population places a major emphasis on comprehensive assessment and appropriate risk stratification of individual patients with hypertension, according to a report published online Oct. 4 in Hypertension and reported by HealthDay News.

John M. Flack, MD, of Wayne State University (Detroit), and colleagues reviewed new data on hypertension and cardiovascular disease (CVD) prevention and treatment guidelines, pharmacological hypertension clinical end-point trials, and blood pressure (BP)-lowering trials in African Americans to update the 2003 ISHIB consensus statement. In the new statement, the researchers divided African American patients with hypertension into primary (no evidence of end-organ damage, preclinical CVD, or CVD) and secondary (evidence of end-organ damage, preclinical CVD, or history of CVD) prevention groups.

The updated consensus statement lowers the target BP level to less than 135/85 mm Hg for African Americans in the primary prevention group and less than 130/80 mm Hg for those in the secondary prevention group. The statement also advises that intensive lifestyle modifications be recommended for all African Americans having BP of at least 115/75 mm Hg.

Monotherapy with a diuretic or calcium channel blocker is recommended for BP elevations of 10 mm Hg or less above target levels, stepping up to two-drug therapy (renin-angiotensin system blocker plus a calcium channel blocker combination, or in edematous or volume-overload states, a renin-angiotensin system blocker plus a thiazide diuretic) for BP of more than 15/10 mm Hg above target. The statement also describes a multidrug therapy, up to a 4-drug regimen, for difficult-to-control hypertension.

Several authors of the consensus statement and the accompanying editorial disclosed financial relationships with the pharmaceutical industry.