BEYOND CONTROLLING BLOOD-PRESSURE IN THE BLACK PATIENT - METABOLIC CONSIDERATIONS

Hypertension is highly prevalent among African Americans, who are also more likely than whites to develop end-organ complications of hyperte nsion. Traditional diuretic-based step-care therapy has successfully r educed such complications of hypertension as stroke, congestive heart failure, and premature death in all populations tested. Prevention of coronary deaths has been less successful. Potentially adverse metaboli c effects of thiazide diuretics and some beta-blockers may partially e xplain the less successful cardiac outcomes. Use of antihypertensive a gents lacking adverse metabolic effects but still achieving effective blood pressure control could improve cardiac outcomes while maintainin g the benefits achieved with older forms of therapy. Achievement of im proved cardiac outcomes is now one of the principal goals of hypertens ion research and treatment.