Consensus Statement Pushes Lower BP Goals in Blacks

Emphasis on comprehensive risk stratification, early antihypertensive use
By Lindsey Marcellin
HealthDay Reporter

TUESDAY, Oct. 5 (HealthDay News) -- 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.

John M. Flack, M.D., of the Wayne State University in 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 blacks to update the 2003 ISHIB consensus statement. In the new statement, the researchers divided black 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 for blacks in the primary prevention group to less than 135/85 mm Hg, and for those in the secondary prevention group to less than 130/80 mm Hg. The statement also advises that intensive lifestyle modifications be recommended for all blacks 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 more than 15/10 mm Hg above target; the statement also describes multi-drug therapy up to a four-drug regimen for difficult to control hypertension.

"In summary, the new ISHIB consensus document presents useful, practical information to guide practitioners in the diagnosis, prevention, and treatment of hypertension in black patients," write the authors of an accompanying editorial. "However, there is insufficient evidence to support the recommendations for the lower BP goals and the preferential use of one combination drug therapy."

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

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