Understanding the Importance of Race/Ethnicity in the Care of the Hypertensive Patient

Abstract

Although several risk factors contribute to cardiovascular disease (CVD) overall, hypertension (HTN) is the major controllable risk factor. Hypertension is disproportionately more prevalent among Blacks or African-Americans compared with other race/ethnic populations, and the control rates among this disparate population are alarming. Several pathophysiologic mechanisms have been demonstrated and evaluated among hypertensives and the conglomeration of genetics, environmental, and personal lifestyle activities concurrently impact the progression of hypertension-related comorbidities (i.e., chronic renal disease, CVD, stroke, etc.). Specific pharmacotherapeutic choices are discussed and the most up-to-date data is presented to optimize the care of hypertensives. National and international guidelines for the treatment of HTN are reviewed and analyzed, presenting the most appropriate approach to the care of hypertensive patients overall. Additionally, national efforts supporting the goal of early HTN screening and treatment, as well as the variety of evidence-based pharmacotherapy, are summarized, applying to the public health impact overall.

Sedentary Behavior and Blood Pressure in Patients with Multiple Sclerosis

“…The present results are not necessarily generalizable to those with more severe disability or who are nonambulatory, with progressive MS, or who are black, and may not be representative of the entire MS population. The black community, in particular, typically has a more severe disease progression and exhibits higher rates of hypertension, 48 and this warrants a similar study for persons in this demographic group. There is a potential for selection bias and cohort effect bias in the present study, and physically active participants may have preferentially volunteered for this study; however, this does not seem to be the case considering the difference in GLTEQ scores between patients with MS and controls.…”

Hypertension and ethnicity

“…Numerous studies have outlined the possible genetic contributors to HTN among blacks [26][27][28][29][30]. Blacks exhibit low renin levels, leading to additional sodium reabsorption by the kidneys, which in turn contributes to elevated BP [26,27].…”

“…Blacks exhibit low renin levels, leading to additional sodium reabsorption by the kidneys, which in turn contributes to elevated BP [26,27]. Additionally, a more active sodium-potassiumchloride cotransporter in the thick ascending limb of the kidneys has been associated with multiple phenotypes in blacks [26,27].…”

“…Blacks exhibit low renin levels, leading to additional sodium reabsorption by the kidneys, which in turn contributes to elevated BP [26,27]. Additionally, a more active sodium-potassiumchloride cotransporter in the thick ascending limb of the kidneys has been associated with multiple phenotypes in blacks [26,27]. The reduced bioavailability of nitric oxide in blacks has been shown to contribute to both resting and stimulus-mediated vasodilator tone and elevation in BP compared with whites [27][28][29][30].…”

“…The reduced bioavailability of nitric oxide in blacks has been shown to contribute to both resting and stimulus-mediated vasodilator tone and elevation in BP compared with whites [27][28][29][30]. Unique genetic polymorphisms of MYH9 and apolipoprotein L1 genes are associated with the development of kidney disease in blacks [26,27]. Detailed studies of the Genetic Risk Assessment of Heart Failure in African-Americans registries are currently shedding light on the genetic frequency of aldosterone synthase (CYP11B2) and endothelial constitutive nitric oxide synthase within both black and white populations [17,[31][32][33].…”