The American Medical Association has issued new blood pressure guidelines through it’s Joint National Committee 1 (JNC). The eighth edition (JNC 8) has important information for Black Americans since over forty percent of Black Americans have high blood pressure2 according to Centers for Disease Control and Prevention (CDC). High blood pressure is one the major contributing factors3 (CDC) in the deaths of African Americans. High blood pressure can lead to strokes4 (CDC) and heart attacks5 (National Institutes Of Health), two of the leading causes of reduced quality of life, and death.
The new guidelines emphasize control of high blood pressure with age and comorbidity-specific treatment cutoffs. A comorbidity is a disease existing simultaneously with, and usually independently of, another medical condition. For example, someone can have hypertension (high blood pressure) and not have diabetes. But, on the other hand, someone with diabetes very often has hypertension too.
Jay Harold will focus on the patients of African descent. The changes in JNC 8 are crucial since many Black Americans did not know or follow the previous guidelines.
Drugs Used to Reduce High Blood Pressure in African-Americans
We will give a brief and simplified description of the four different classes of medications recommended for use by Black Americans. Remember to consult your doctor or pharmacist for more detailed information.
Diuretics are among the most commonly used drugs. They act by reducing sodium (salt) reabsorption at different sites in the nephron (kidney), thereby increasing urinary (urine) sodium and water losses. The ability to cause loss of fluids in the body has made diuretics useful in the treatment of a variety of conditions, particularly excess fluid (swelling) states and hypertension.
Thiazide-type diuretics act on the distal tubule6 of the kidney and appear to be effective for people of African descent per Recommendation 7 of JNC 87. It is partly responsible for the regulation of potassium, sodium and calcium. Examples of thiazide diuretics include hydrochlorothiazide, chlorthalidone, indapamide, and metolazone. Thiazide diuretics have some side effects, including impotence and electrolyte changes. Talk to your doctor to choose the drugs within this class that minimizes these side effects.
Calcium Channel Blockers
Recommendation 7 of JNC 8 also applies to Calcium Channel Blockers (CCBs). Calcium channel blockers8 (CCBs) prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. Calcium channel blockers relax and widen blood vessels by affecting the muscle cells in the arterial walls. Some CCBs have the added benefit of slowing your heart rate, which can further reduce blood pressure, relieve chest pain (angina) and control an irregular heartbeat. Medications representative of this class includes amlodipine, diltiazem, nifedipine and verapamil. Side effects include dizziness, headache, and constipation.
Angiotensin Converting Enzyme Inhibitors
Angiotensin-converting enzyme inhibitors9 (ACEIs) are used to treat heart disease. These medicines make your heart work less hard by lowering your blood pressure. This keeps some kinds of heart disease from getting worse. Most people who have heart failure take these medicines.
These medicines treat high blood pressure, strokes, or heart attacks. They are also used to treat diabetes and kidney problems. Enalapril, (Vasotec), lisinopril (Zestril), and ramipril (Altace). Side effects exhibited include a cough, dizziness, and high potassium levels.
Angiotensin II Receptor Blockers
Angiotensin II Receptor Blockers10 (ARBs) inhibit a substance that causes blood vessels to narrow (constrict). As a result, blood vessels relax and widen (dilate), making it easier for blood to flow through the vessels, which reduces blood pressure. These medicines also increase the release of water and salt (sodium) to the urine, which in turn lowers blood pressure as well. Preventing the blood vessels from constricting helps improve blood flow, which reduces the backup of blood in the heart and lungs. It also decreases the pressure that the left ventricle of the heart must pump against. Angiotensin II receptor blockers also act directly on the hormones that regulate sodium and water balance. Side effects can include dizziness, sinus problems and stomach problems. Commonly prescribed medications in this class are losartan (Cozaar), valsartan (Diovan) and olmesartan (Benicar).
Best High Blood Pressure Drug Choices for Black Americans
Jay Harold has to get into more detail now because you need to know what studies were used to draw these conclusions.
Michael Page’s In-Depth Guide on JNC 811 states that ACEIs and ARBs may not be an ideal choice in patients of African descent. Results of a subgroup analysis in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found that ACEIs led to worse cardiovascular outcomes than thiazide-type diuretics or CCBs in patients with African ancestry.
Despite the subgroup analysis of ALLHAT, results of the African American Study of Kidney Disease and Hypertension (AASK) support the use of first-line or add-on ACEIs to improve kidney-related outcomes in patients of African descent with hypertension, chronic kidney disease, and proteinuria. Proteinuria is a condition in which urine contains an abnormal amount of protein. As a result, the JNC 8 panelists recommend that all patients with chronic kidney disease and hypertension, regardless of ethnic background, should receive treatment with an ACEI or ARB to protect kidney function, either as initial therapy or add-on therapy.
One exception to the use of ACEIs or ARBs in the protection of kidney function applies to patients over the age of 75. The panel cited the potential for ACEIs and ARBs to increase serum creatinine and produce hyperkalemia (high potassium level in blood). As a result, for patients over the age of 75 with decreased renal function, thiazide-type diuretics or CCBs are an acceptable alternative to ACEIs or ARBs. Also, the panel expressly prohibits the simultaneous use of an ACEI and an ARB in the same patient. This combination has not been shown to improve outcomes.
When Will The Meds Start Working?
The JNC 8 guideline authors simplified a complicated recommendation for follow-up in patients with hypertension.
The JNC 7 panel recommended that after an initial high blood pressure reading, follow-up with a confirmatory blood pressure reading should occur within 7 days to 2 months, depending on how high the first reading was and whether or not the patient had kidney disease or end-organ damage as a result of hypertension.
Under JNC 8, in all cases, goal blood pressure targets should be reached within a month of starting treatment either by increasing the dose of the initial drug or by using a combination of medications. This is Recommendation 9 of the JNC 8 report.
Ways to Reduce High Blood Pressure without Drugs
The National Institutes of Health offers ways to prevent the long-term problems High Blood Pressure causes. Healthy lifestyle habits can help you maintain normal blood pressure.
- Follow a healthy diet. Limit the amount of sodium (salt) and alcohol that you consume. The National Heart, Lung, and Blood Institute’s DASH (Dietary Approaches to Stop Hypertension) eating plan12 promote healthy eating.
- Be physically active. Routine physical activity can lower high blood pressure (HBP) and reduce your risk for other health problems.
- Maintain a healthy weight. Staying at a healthy weight can help you control HBP and reduce your risk for other health issues.
- Quit smoking. Smoking can damage your blood vessels and raise your risk for HBP. Smoking also can worsen health problems related to HBP.
- Learn to manage and cope with stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
Many people who adopt these healthy lifestyle habits can prevent or delay HBP. The more lifestyle changes you make, the more likely you are to lower your blood pressure and avoid related health problems. For more information about healthy lifestyle habits, go to “How Is High Blood Pressure Treated13?”
Jay Harold has a handy medication guide on High Blood Pressure for Black Americans. Learn more by reviewing “African American Med Guide for High Blood Pressure.”
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