Consensus statement lowers BP goals in blacks to manage hypertension

An updated consensus statement on the management of hypertension among blacks places a major emphasis on a comprehensive assessment and appropriate risk stratification of individual patients with hypertension, according to a report published online Oct. 4, 2010 in Hypertension, HealthDay News reported.

An updated consensus statement on the management of hypertension among blacks places a major emphasis on a comprehensive assessment and appropriate risk stratification of individual patients with hypertension, according to a report published online Oct. 4, 2010 in Hypertension, HealthDay News reported.

John M. Flack, MD, of Wayne State University 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 International Society on Hypertension in Blacks (ISHIB) consensus statement. The original statement was published in 2003. In the new statement, 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 mmHg, and to less than 130/80 mmHg for those in the secondary prevention group. The statement also recommends intensive lifestyle modifications for all blacks that have a BP of at least 115/75 mmHg.

Monotherapy with a diuretic or calcium channel blocker is recommended for BP elevations of 10 mmHg or less above target levels, stepping up to 2-drug therapy (renin-angiotensin system blocker plus a calcium channel blocker combination or, in edematous and/or volume-overload states, with a renin-angiotensin system blocker plus a thiazide diuretic) for BP of more than 15/10 mmHg above target. The statement also describes a multi-drug therapy, up to a 4-drug regimen, for difficult-to-control hypertension.

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