Hypertension Management in Black Adults

Terminology

• US Census Bureau defines the adjectives Black or African American as denoting US Americans with ancestral origins in any of the Black racial groups of Africa1

• US and European guidelines on hypertension2,3 also use the adjective Black with that intended meaning: US or European people (respectively) with ancestral origins in any of the Black racial groups of Africa

Risk Models and Risk Scores

• For atherosclerotic cardiovascular disease: the ASCVD Risk Estimator, an online calculator by the American College of Cardiology (4,5)

  • Web-based application that uses data obtained from the race- and sex-specific Pooled Cohort Equations (4) to predict 10-year and lifetime risk of atherosclerotic cardiovascular disease (5)

  • May be used to assess individualized cardiovascular risk for patients with hypertension to help define appropriate treatment goals and options;6 it is intended for patients with LDL-C level less than 190 mg/dL, without atherosclerotic cardiovascular disease, and not on LDL-C–lowering therapy (5)

Epidemiology

• Prevalence and control rates of hypertension vary significantly according to racial/ethnic subgroups (7)

• Black Americans develop hypertension and associated organ damage at younger ages, have a higher frequency of resistant hypertension, and have a higher risk of end-organ damage including stroke, heart failure, and kidney disease, culminating in greater hypertension-associated mortality, than other racial/ethnic American subgroups (7-9)

  • For epidemiologic purposes, presence of hypertension can be defined as (1) systolic blood pressure of 130 mm Hg or more or diastolic blood pressure of 80 mm Hg or more; (2) if the person said yes to taking antihypertensive medication; or (3) if the person has been told by a health care professional on 2 or more occasions that they had hypertension.10 By that definition, the prevalence of hypertension among Black Americans is high, with an age-adjusted prevalence of 56.6% (males) and 55.3% (females) between 2015 and 2018 (10)

  • Black Americans with hypertension are at 1.8 times higher risk of fatal stroke, 1.5 times higher risk of heart failure, and 4.2 times higher risk of end-stage renal disease compared with the cohort of Americans who are White, Hispanic, or both (2)

  • Among Americans recommended to take blood pressure medication, blood pressure control is higher among non-Hispanic White adults (32%) than among non-Hispanic Black adults (25%), non-Hispanic Asian American adults (19%), or Hispanic adults (25%) (11)

  • Age-adjusted, hypertension-attributable mortality rates are higher for non-Hispanic Black Americans (males and females) than for other racial/ethnic subgroups (2)

• Social determinants of health and environmental factors likely play a significant role in how hypertensive disease manifests within the Black patient population (9,12)