Better care for hypertension urged

Doctors say blacks need aggressive treatment

March 11, 2003|By Jonathan Bor | Jonathan Bor,SUN STAFF

Physicians are calling for more aggressive treatment of hypertension in black patients, saying that stepped-up medication and a healthier diet can reduce the steep toll that high blood pressure takes on African-Americans.

Doctors with the International Society of Hypertension in Blacks say doctors should start black patients on two drugs rather than one, and push exercise, weight loss and a diet rich in fruits, vegetables and fiber.

The group, writing in a national medical journal, said doctors should also set out to reduce black patients' blood pressure to a lower level than they would with other groups.

"We have compelling evidence that African-Americans are significantly more likely to die from the consequences of high blood pressure than the general public, and that may be because current treatment strategies have not been very successful," Dr. Elijah Saunders, a heart specialist at the University of Maryland Medical Center, said yesterday.

The new guidelines appearing in today's Archives of Internal Medicine were prepared by physicians with the hypertension society. Saunders, a co-author, was a founding member of the medical group.

High blood pressure puts patients at greatly increased risk of heart attacks and strokes. The condition is about twice as common among blacks as in whites under 50, occurring in about a quarter of blacks in that age group. The incidence rises in all patients as they age, but remains higher among blacks.

The reasons remain unclear, though doctors suspect a combination of diet, poverty, poor access to health care and genetics. Although it remains unproved, some experts have suspected that blacks are more sensitive to salt, which can raise blood pressure.

"The best we can say is that there might be some genetic predisposition, but that doesn't seem to be sufficient in and of itself," Saunders said.

Doctors usually start hypertensive patients on one medication, then add another several weeks later if blood pressure is not substantially lowered. Under the new guidelines, doctors should immediately start black patients on two drugs - a diuretic and perhaps an ACE inhibitor - that attack the problem in different ways.

According to the new guidelines, physicians should also encourage the so-called DASH diet - for Dietary Approaches to Stop Hypertension. It emphasizes fruits, vegetables, fiber and low-fat dairy food. It also calls for more poultry, less red meat, and minimal salt.

The same steps are usually recommended for all patients, regardless of ethnic group, who have diabetes in addition to high blood pressure, or who don't respond to less aggressive measures.

Physicians should also set out to lower blood pressure to 130 over 80 milligrams of mercury, a more ambitious goal than that set for other patients.

At a news briefing yesterday, 69-year-old William Hankins urged other black patients to take their condition seriously. Diagnosed 10 years, ago, he was able to reduce his blood pressure from 160 over 90 to about 120 over 80, and has enjoyed good health.

"There are a lot of needless deaths that could be averted if people are aware of the problem," said Hankins, a retired hospital administrator from Baltimore who concedes that he still needs to lose weight and exercise more. "They can live much longer if they get into a good treatment program."

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