Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
letter
. 1988 Mar;80(3):265–272.

Treatment of Hypertension in Black Patients With Angiotensin-Converting Enzyme Inhibitors

Neil B Shulman
PMCID: PMC2625639  PMID: 3280812

Abstract

The prevalence of hypertension and the incidence of complications from uncontrolled elevated blood pressure in blacks is much greater than in the white population. In general, blacks have underlying differences in the factors relating to blood pressure level, including low plasma renin, and, in certain instances, a decreased ability to excrete sodium. The stepped-care approach in the management of the black hypertensive patient is similar to that taken with white patients, but racial differences in response to antihypertensive drugs exist that require careful consideration when choosing a treatment regimen. Thiazide diuretics are effective in blacks and are often used as initial therapy. Blacks tend to respond less well to β-blockers, but when combined with a diuretic, they are also effective. Encouraging data are available on the use of calcium channel blockers in blacks. When combined with a diuretic, the angiotensin-converting enzyme (ACE) inhibitors also provide an alternative to therapy for black patients. The use of low doses of ACE inhibitors has reduced the high incidence of adverse effects associated with this group of drugs in earlier studies.

Full text

PDF
265

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ambrosioni E., Borghi C., Costa F. V. Captopril and hydrochlorothiazide: rationale for their combination. Br J Clin Pharmacol. 1987;23 (Suppl 1):43S–50S. doi: 10.1111/j.1365-2125.1987.tb03121.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ando K., Fujita T., Ito Y., Noda H., Yamashita K. The role of renal hemodynamics in the antihypertensive effect of captopril. Am Heart J. 1986 Feb;111(2):347–352. doi: 10.1016/0002-8703(86)90152-3. [DOI] [PubMed] [Google Scholar]
  3. Chellingsworth M., Beevers D. G. The treatment of hypertension in the elderly. Postgrad Med J. 1986 Jan;62(723):1–5. doi: 10.1136/pgmj.62.723.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chrysant S. G., Danisa K., Kem D. C., Dillard B. L., Smith W. J., Frohlich E. D. Racial differences in pressure, volume and renin interrelationships in essential hypertension. Hypertension. 1979 Mar-Apr;1(2):136–141. doi: 10.1161/01.hyp.1.2.136. [DOI] [PubMed] [Google Scholar]
  5. De Gaudemaris R., Battistella P., Siche J. P., Debru J. L., Blatier J. F., Mallion J. M. Comparative study of the efficacy of captopril at a single daily dose of 100 mg and at a twice daily dose of 50 mg by measuring ambulatory pressure over 24 hours. Postgrad Med J. 1986;62 (Suppl 1):97–100. [PubMed] [Google Scholar]
  6. Edwards C. R., Padfield P. L. Angiotensin-converting enzyme inhibitors: past, present, and bright future. Lancet. 1985 Jan 5;1(8419):30–34. doi: 10.1016/s0140-6736(85)90975-4. [DOI] [PubMed] [Google Scholar]
  7. Fadayomi M. O., Akinroye K. K., Ajao R. O., Awosika L. A. Monotherapy with nifedipine for essential hypertension in adult blacks. J Cardiovasc Pharmacol. 1986 May-Jun;8(3):466–469. doi: 10.1097/00005344-198605000-00004. [DOI] [PubMed] [Google Scholar]
  8. Flamenbaum W. Propranolol versus labetalol: interesting differences in efficacy. J Natl Med Assoc. 1985 May;77 (Suppl):14–23. [PMC free article] [PubMed] [Google Scholar]
  9. Freier P. A., Wollam G. L., Hall W. D., Unger D. J., Douglas M. B., Bain R. P. Blood pressure, plasma volume, and catecholamine levels during enalapril therapy in blacks with hypertension. Clin Pharmacol Ther. 1984 Dec;36(6):731–737. doi: 10.1038/clpt.1984.250. [DOI] [PubMed] [Google Scholar]
  10. Frishman W., Charlap S., Kimmel B., Saltzberg S., Stroh J., Weinberg P., Monuszko E., Wiezner J., Dorsa F., Pollack S. Twice-daily administration of oral verapamil in the treatment of essential hypertension. Arch Intern Med. 1986 Mar;146(3):561–565. [PubMed] [Google Scholar]
  11. Frohlich E. D., Cooper R. A., Lewis E. J. Review of the overall experience of captopril in hypertension. Arch Intern Med. 1984 Jul;144(7):1441–1444. [PubMed] [Google Scholar]
  12. Grell G. A., Forrester T. E., Alleyne G. A. Comparison of the effectiveness of a beta blocker (atenolol) and a diuretic (chlorthalidone) in black hypertensive patients. South Med J. 1984 Dec;77(12):1524–1529. doi: 10.1097/00007611-198412000-00012. [DOI] [PubMed] [Google Scholar]
  13. Holland O. B., Chud J. M., Braunstein H. Urinary kallikrein excretion in essential and mineralocorticoid hypertension. J Clin Invest. 1980 Feb;65(2):347–356. doi: 10.1172/JCI109678. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jenkins A. C., Dreslinski G. R., Tadros S. S., Groel J. T., Fand R., Herczeg S. A. Captopril in hypertension; seven years later. J Cardiovasc Pharmacol. 1985;7 (Suppl 1):S96–101. [PubMed] [Google Scholar]
  15. Luft F. C., Rankin L. I., Bloch R., Weyman A. E., Willis L. R., Murray R. H., Grim C. E., Weinberger M. H. Cardiovascular and humoral responses to extremes of sodium intake in normal black and white men. Circulation. 1979 Sep;60(3):697–706. doi: 10.1161/01.cir.60.3.697. [DOI] [PubMed] [Google Scholar]
  16. Materson B. J. Black/white differences in response to antihypertensive therapy. J Natl Med Assoc. 1985 May;77 (Suppl):9–13. [PMC free article] [PubMed] [Google Scholar]
  17. Millar J. A., Derkx F. H., McLean K., Reid J. L. Pharmacodynamics of converting enzyme inhibition: the cardiovascular, endocrine and autonomic effects of MK421 (enalapril) and MK521. Br J Clin Pharmacol. 1982 Sep;14(3):347–355. doi: 10.1111/j.1365-2125.1982.tb01990.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Moser M., Lunn J. Comparative effects of pindolol and hydrochlorothiazide in black hypertensive patients. Angiology. 1981 Aug;32(8):561–566. doi: 10.1177/000331978103200806. [DOI] [PubMed] [Google Scholar]
  19. Moser M., Lunn J. Responses to captopril and hydrochlorothiazide in black patients with hypertension. Clin Pharmacol Ther. 1982 Sep;32(3):307–312. doi: 10.1038/clpt.1982.165. [DOI] [PubMed] [Google Scholar]
  20. Persky V., Pan W. H., Stamler J., Dyer A., Levy P. Time trends in the US racial difference in hypertension. Am J Epidemiol. 1986 Nov;124(5):724–737. doi: 10.1093/oxfordjournals.aje.a114448. [DOI] [PubMed] [Google Scholar]
  21. Schachter J., Kuller L. H. Blood volume expansion among blacks: an hypothesis. Med Hypotheses. 1984 May;14(1):1–19. doi: 10.1016/0306-9877(84)90057-4. [DOI] [PubMed] [Google Scholar]
  22. The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1984 May;144(5):1045–1057. [PubMed] [Google Scholar]
  23. Thomson G. E. Latest guidelines on the treatment of high blood pressure. J Natl Med Assoc. 1985 May;77 (Suppl):7–8. [PMC free article] [PubMed] [Google Scholar]
  24. Todd P. A., Heel R. C. Enalapril. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure. Drugs. 1986 Mar;31(3):198–248. doi: 10.2165/00003495-198631030-00002. [DOI] [PubMed] [Google Scholar]
  25. Vlasses P. H., Conner D. P., Rotmensch H. H., Fruncillo R. J., Danzeisen J. R., Shepley K. J., Ferguson R. K. Double-blind comparison of captopril and enalapril in mild to moderate hypertension. J Am Coll Cardiol. 1986 Mar;7(3):651–660. doi: 10.1016/s0735-1097(86)80477-6. [DOI] [PubMed] [Google Scholar]
  26. Weinberger M. H. Blood pressure and metabolic responses to hydrochlorothiazide, captopril, and the combination in black and white mild-to-moderate hypertensive patients. J Cardiovasc Pharmacol. 1985;7 (Suppl 1):S52–S55. doi: 10.1097/00005344-198507001-00011. [DOI] [PubMed] [Google Scholar]
  27. van Zwieten P. A., de Jonge A. Interaction between the adrenergic and renin-angiotensin-aldosterone-systems. Postgrad Med J. 1986;62 (Suppl 1):23–27. [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES