Choosing the Right Early Hypertension Treatment for African-American Patients Essay

First-Choice Drug Classification for Early Hypertension

Angiotensin receptor blockers (ARBs) or ACE inhibitors (ACEi) are the drug classification that has taken the first choice in most patients with early hypertension. The starting drug dose should typically be low, whether treatment is started with one or two agents (Mann & Flack, 2023). The ARBs are an exception since, in many patients, their maximum antihypertensive effect is moderate, and they do not induce severe dose-related adverse effects. (Mann & Flack, 2023) Therefore, starting with medium to high doses of ARBs as the first choice for hypertension is reasonable because it prevents unnecessary dose titration.

Evaluating the Use of Thiazide Diuretics and Beta Blockers in Hypertension Treatment

An ACEi or ARB, a calcium channel blocker (CCB), or a Thiazide Diuretic are the four main alternatives for antihypertensive medication therapy in most patients. Nevertheless, it is not best to select a Thiazide Diuretic or a beta blocker as was once done. If there is no compelling reason to choose a specific drug class, starting with ACEi, ARB, or a dihydropyridine calcium channel blocker (DCCB) rather than Thiazide Diuretic or Beta Blockers is recommended (Mann & Flack, 2023).

The four main alternatives produce similar benefits on cardiovascular endpoints, but an ACE inhibitor and a DCCB combination have superior protection. The combination has far better protection than a Thiazide Diuretic with the same ACE inhibitor (Mann & Flack, 2023). Therefore, starting with a Thiazide Diuretic or a Beta Blocker as the first choice for early hypertension is no longer advisable.

Primary Treatment Options for African American Patients with Hypertension

In cases of treating African American patients, the first-line therapy option should be a thiazide or calcium channel blocker. Studies have shown that ACEi and ARB are less effective at preventing hypertension in patients of African-American origin (Leake, 2019). If starting two agents, choosing an ACEi inhibitor or ARB along with a Thiazide or CCB is reasonable. However, it is best to avoid ACEi or ARB if one must choose only one.

References

Leake, I. (2019). Lowering blood pressure in black African patients. Nature Reviews Cardiology, 16(6), 323. Web.

Mann, J., & Flack, J. (2023). Choice of drug therapy in primary (essential) hypertension. UpToDate. Web.