Well over half of all African-American adults will be classified as having high blood pressure under new streamlined diagnostic guidelines illuminating the heavy burden of cardiovascular disease in the population.
Anyone with blood pressure higher than 130/80 will be
considered to have hypertension, or high blood pressure, the American Heart
Association and American College of Cardiology stated Monday in releasing their
new joint guidelines. That changes from 140/90, where the diagnostic
guideline had been since 1993.
“Rather than one in three U.S. adults having high blood
pressure (32 percent) with the previous definition, the new guidelines will
result in nearly half of the U.S. adult population (46 percent) having high
blood pressure, or hypertension,” the groups stated.With the change, it is estimated that 59 percent of all African-American men will be classified as having high blood pressure, up from 42 percent. Fifty-six percent of African-American women - who had the highest rate previously at 46 percent - now have high blood pressure. Forty-seven percent of white men and 41 percent of white women have high blood pressure.
“Earlier intervention is important for African-Americans,”
said Dr. Kenneth A. Jamerson, a guideline author, cardiologist and professor of
cardiovascular medicine with the University of Michigan Health System.
“Hypertension occurs at a younger age for
African-Americans than for whites. By the time the 140/90 is achieved, their
prolonged exposure to elevated blood pressure has a potential for worse
outcome.”Heart disease also develops earlier in African-Americans and high blood pressure plays a role in more than 50 percent of all deaths from it. African-Americans have a higher rate of heart attacks, sudden cardiac arrest, heart failure and strokes than white people.
In addition, the risk for African-Americans is 4.2 times greater for end-stage renal disease, which often progresses to the need for dialysis multiple times a week and ultimately to kidney transplantation or death.
“Hypertension has been a blight on the African-American community for many, many years. It’s time for us to get over it,” said Dr. Kim Allan Williams Sr., chief of cardiology at Rush University Medical Center in Chicago. “People need to get screened and get care.”
The new guidelines are expected to offer new ways for
medical providers to work with patients, who will be asked to modify their
lifestyle by quitting smoking, drinking no alcohol or moderate amounts,
eating a healthy diet and exercising regularly.
“You may not have to take a pill,” said Dr. Jamerson.
“These discussions are more work for a provider, but it’s great for the
patient. They’re brought into the process.”
If medicine is needed, the new directions are to treat
earlier and more aggressively to get blood pressure into the normal range right
off the bat. “Our data shows controlling early works,” Dr. Jamerson
said.
That’s different from the old-school way of prescribing
one drug and slowly upping the dose or adding other meds if the patient doesn’t
reach the target.
The guidelines also offer race-specific treatment
recommendations by addressing drug efficacy in African-Americans. The
guidelines point out that thiazide-type diuretics and/or calcium channel
blockers are more effective in lowering blood pressure in African-Americans
when given alone or at the beginning of multidrug regimens.
Dr. Jamerson said there is no downside to more
aggressively treating high blood pressure from the start. “If one takes the long view, then everyone should
appreciate this approach,” he said. “The cost of medications to treat more
people is small when compared to the cost of a stroke, cardiovascular disease
or heart failure. It’s a no-brainer.”
