Hypertension in blacks is such a serious health problem that treatment thresholds should be lowered and providers should quickly move to multidrug therapy to keep BP comfortably below the thresholds.
These recommendations are presented in a new consensus statement from the International Society on Hypertension in Blacks (ISHIB), published in the journal Hypertension. The updated statement draws on data from clinical trials that have become available since the group’s 2003 recommendations.
The ISHIB statement divides patients into two risk strata: (1) In primary prevention, BP consistently <135/85 mm Hg is recommended for individuals with elevated BP without target organ damage, preclinical cardiovascular disease (CVD), or overt cardiovascular disease; (2) in secondary prevention, BP consistently <130/80 is recommended for individuals with target organ damage, preclinical CVD, and/or a history of CVD.
The ISHIB prefers monotherapy with a diuretic or calcium channel blocker (CCB) when BP rises ≥10 mm Hg above target levels. When BP increases >15/10 mm Hg above target, the group advises the use of two-drug therapy with either a CCB plus a renin-angiotensin system (RAS) blocker, or—in edematous and/or volume overload states—with a thiazide diuretic plus an RAS blocker. The consensus statement describes effective multidrug combinations through four drugs. The adoption of comprehensive lifestyle modifications to lower BP when the reading reaches or exceeds 115/75 is also recommended.