黑人种族在高血压治疗中的作用不断发展。

IF 3.2 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE American Journal of Hypertension Pub Date : 2024-09-16 DOI:10.1093/ajh/hpae093
John M Flack, Stephanie Bitner, Michael Buhnerkempe
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引用次数: 0

摘要

根据种族间(相同药物)和种族内(不同药物)的主要血压反应模式,黑人种族被用来指导黑人患者的降压药物选择。因此,对黑人患者推荐使用噻嗪类利尿剂和钙拮抗剂,而不是肾素血管紧张素系统(RAS)抑制剂(血管紧张素受体阻滞剂、血管紧张素转换酶抑制剂)和β受体阻滞剂。目前的降压药物处方反映了历史指导,因为黑人患者比白人患者使用钙离子拮抗剂和噻嗪类利尿剂较多,而使用 RAS 阻滞剂较少。黑人的高血压控制率落后于白人,尽管他们更多地使用联合药物疗法,而较少使用单一疗法。这种情况同样适用于包含四类推荐药物中任何一类药物的初始治疗方案,以及基于证据的联合用药治疗方案(钙拮抗剂或噻嗪类利尿剂 + RAS 阻断剂),在这些方案中,血压反应没有已知的种族差异。目前的建议承认大多数患者,尤其是黑人患者需要联合用药治疗。一项示范性综合高血压控制计划在黑人和白人患者中的控制率达到了 80% 以上,种族差异极小,同时采用了种族诊断治疗算法。黑人患者对饮食/生活方式的调整表现出强劲的血压反应,甚至超常。重要的是,种族似乎既不是选择有效药物治疗的必要考虑因素,也不是充分考虑因素。因此,我们呼吁在对黑人患者进行充分密集的种族定向药物治疗的同时,更加重视饮食/生活方式的调整,以此作为高血压种族定向治疗方法的基石。
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Evolving the Role of Black Race in Hypertension Therapeutics.

Black race has been used to guide antihypertensive drug selection for Black patients based on predominant between race (same drug) and intra-race (different drugs) blood pressure (BP) response patterns. Accordingly, thiazide diuretics and calcium antagonists have been recommended over renin-angiotensin system (RAS) inhibitors (angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors) and beta blockers for Black patients. Current antihypertensive drug prescribing reflects historical guidance as calcium antagonists and thiazide diuretics are prescribed more and RAS blockers less in Black than White patients. Hypertension control rates in Blacks, lag those for Whites despite their greater use of combination drug therapy and lesser use of monotherapy. This is also true across drug regimens containing any of the 4 recommended classes for initial therapy as well as for evidence-based combination drug therapy (calcium antagonist or thiazide diuretic + RAS blocker) regimens for which there is no known racial disparity in BP response. Current recommendations acknowledge the need for combination drug therapy in most, especially in Black patients. One exemplary comprehensive hypertension control program achieved >80% control rates in Black and White patients with minimal racial disparity while utilizing a race-agnostic therapeutic algorithm. Black patients manifest robust, if not outsized, BP responses to diet/lifestyle modifications. Importantly, race neither appears to be a necessary nor sufficient consideration for the selection of effective drug therapy. Accordingly, we urge the initiation of adequately intense race-agnostic drug therapy coupled with greater emphasis on diet/lifestyle modifications for Black patients as the cornerstone of a race-informed approach to hypertension therapeutics.

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来源期刊
American Journal of Hypertension
American Journal of Hypertension 医学-外周血管病
CiteScore
6.90
自引率
6.20%
发文量
144
审稿时长
3-8 weeks
期刊介绍: The American Journal of Hypertension is a monthly, peer-reviewed journal that provides a forum for scientific inquiry of the highest standards in the field of hypertension and related cardiovascular disease. The journal publishes high-quality original research and review articles on basic sciences, molecular biology, clinical and experimental hypertension, cardiology, epidemiology, pediatric hypertension, endocrinology, neurophysiology, and nephrology.
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