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Wednesday, March 12, 2003Doctors 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. ...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 first glance, it seems that the group is recommending over-agressive approach in all individuals to improve the mean. But, the actual guidelines are more nuanced. It doesn’t recommend starting all hypertensive black patients on two medications right off, just those with very high blood pressure or with other risk factors: First, we recommend lower blood pressure goals for patients with diabetes or with nondiabetic renal disease accompanied by proteinuria characterized by more than 1 g/d (<130/80 mm Hg). Second, we recommend the use of combination therapy as first-line therapy for patients with an SBP [systolic blood pressure, i.e. the top number -ed.] of 15 mm Hg or more or a DBP [diastolic blood pressure, i.e. the lower number - ed.] of 10 mm Hg or more above target blood pressure. It’s true that as a group, African-Americans suffer more from the complications of hypertension - kidney disease, heart disease, and strokes. But, the reason for those higher rates isn’t crystal clear. Is there some genetic difference that makes high blood pressure more deadly or harder to treat? Or is it because of issues that transcend race, such as poverty, poorer access to healthcare and to medicines, and lower education levels, all of which are associated with poorer compliance with medical regimens? If the former, then this approach will be beneficial. If the latter, then it really won’t do much to improve the situation. UPDATE: A reader sent this observation: About three years ago, I read an article that said the high-blood pressure in blacks was due to genetics. During the voyage from Africa to the US. the slaves were not given enough water. So only the slaves which had high salt retention would survive. The rest would perish. High salt retention causes high blood pressure. Right? The recent test on high blood pressure medicines showed that the durietics worked best on blacks. I thought that reinforced the slave ship theory. Hmmm. Interesting theory. But, I'm dubious. Do blacks in Africa have lower blood pressures than American blacks? (Or at least do prosperous, healthy, well-fed African blacks have lower blood pressures than American blacks?.) Besides, today's African-Americans aren't the genetically pure Africans that crossed the ocean so long ago. There's been a whole lot of gene pooling since then. They're as much a part of the melting pot that is America as the rest of us. But, it does raise an interesting point. There probably are genes that are at least partially responsible for high blood pressure. If we could identify those genes, we could aim aggressive treatment at those who possess them. That would be far more accurate than basing treatment on skin color. posted by Sydney on 3/12/2003 08:27:00 AM 0 comments 0 Comments: |
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