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The medical care of black patients with hypertension (high blood pressure) presents some challenges to physicians. Hypertension is more prevalent among blacks than nonblacks and there is a higher proportion of blacks with uncontrolled hypertension. At an earlier age, black patients may have more severe coronary artery disease, congestive heart failure, stroke, peripheral vascular disease, and end-stage renal (kidney) disease. Black hypertensives are frequently younger than their nonblack counterparts, and they are less likely to be compliant with medication schedules. Recent studies have demonstrated that calcium channel blockers are equally effective in controlling blood pressure in black and nonblack patients. It has also been demonstrated that blacks do not respond as well to converting enzyme inhibitors or beta-blockers as do nonblack patients. Three hundred ninety-four black patients with hypertension were studied to compare the effects of the three major classes of hypotensive agents: beta-blockers, calcium channel blockers, and converting enzyme inhibitors. In addition, the efficacy, safety, and quality of life associated with atenolol, captopril, and verapamil sustained release (SR) given for mild to moderate hypertension were evaluated in black patients. The study was broken down into four periods: a two- to four-week lead-in with placebo; four weeks of initial therapy; four weeks of forced titration and maintenance; and one week of final therapy. There was a greater drop in diastolic and systolic blood pressures with verapamil SR than with the other treatments. All three agents were efficacious in controlling blood pressure in the black patients studied, but the calcium channel blocker was more effective in all three active-treatment study periods. Verapamil SR also produced a trend toward a dose-response for reducing systolic blood pressure that was not seen with the other two drugs, although the effect was not statistically significant. Most black patients exhibit a lower renin profile and previous studies have suggested that these patients do not respond as well to beta-blockers or converting enzyme inhibitors. Hypertensive blacks have problems with elevated peripheral resistance and they appear to be well suited to treatment with calcium antagonists from a pathophysiologic standpoint. It is important to remember that drugs that are effective in some patients are not necessarily effective in other groups. Greater effort needs to be made to individualize treatment rather than follow the traditional stepped approach to the management of hypertension. (Consumer Summary produced by Reliance Medical Information, Inc.)

There have been many reports of racial differences in response to antihypertensive medications. Many improvements have occurred in the ability to determine the most appropriate antihypertensive medication for an individual patient. The comparative benefits of antihypertensive agents on the quality of life of black patients have not been fully assessed in large clinical trials. There also may be differences in the quality of life between male and female hypertensive patients. A group of 306 black men and women with mild to moderate hypertension was studied to determine the measures of quality of life associated with treatment with three antihypertensives (atenolol, a beta-blocker; captopril, an angiotensin-converting enzyme inhibitor; and verapamil SR, a sustained-release calcium channel blocker) during an eight-week treatment period. There were five quality of life measures studied: sense of well-being and satisfaction with life, physical state, emotional state, intellectual functioning, and ability to perform in social roles. Adverse reactions were not found to have a negative effect on the quality of life areas studied. There was no association between age and change in quality of life measures. Among male and female patients studied, comparisons between drug treatment groups showed no differences in degree of change on the total quality of life scale scores. There was a general lack of difference in quality of life between the three drugs. Physicians have an increasing number of antihypertensive agents to choose from and they can tailor drug therapy better to the needs of their black patients. Changes in quality of life status can be assessed through the psychosocial measures used in this study. (Consumer Summary produced by Reliance Medical Information, Inc.)