Management of the Black Hypertensive Patient in a Resource-Limited Setting

摘要

Hypertension is by far the most important modifiable risk factor for cardiovascular disease in sub-Saharan Africa. Studies have documented the prevalence of hypertension to be highest in blacks and the incidence and progression of end-organ damage from hypertension are worse in black patients. For example the risk of stroke is double in hypertensive black patients compared with white hypertensive patients. Hypertension in blacks is strongly associated with a lot of other modifiable risk factors for CVD such as obesity, physical inactivity and reduced potassium intake. This observation also applies to black patients in USA and Europe. Consequently, effective treatment of hypertension is particularly important in black patients. Calcium channel blockers and diuretics are effective monotherapy in blacks. Beta blockers, alpha adrenergic blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are less effective as monotherapy. They are however effective as combination therapy which is particularly attractive for black patients. Medical education is important in hypertensive black patients because of the cluster of modifiable risk factors and socioeconomic considerations.