African Americans with hypertension are at increased risk for serious complications. Hypertensive Blacks have a high rate of cardiovascular disease, stroke and renal failure. These can often be prevented by careful attention to the various contributory factors that may be present.


Contributory Factor


delayed diagnosis

regular population screening starting at an early age


weight loss to achieve ideal weight

diet high in fats and salt

reduce fat and salt in diet, use the DASH diet

salt sensitivity

minimize salt intake


discontinue use of nicotine

ethanol use

abstain from alcohol or use in moderation

drug abuse

discontinue illicit drug abuse

poor access to healthcare

improve access to healthcare, especially if reliant on the Emergency Department for care

distrust of healthcare

develop a long-term relationship with trust

unable to afford medications

assistance in purchasing medications

poor adherence to therapy

identify noncompliance and respond to its causes; regular blood pressure monitoring

diabetes mellitus

manage aggressively

renal disease

manage aggressively, especially if proteinuria present

response to anti-hypertensive medications

combination therapy with two agents is often effective (see below)


monitor for and replace potassium deficiency

lead poisoning

screening and treatment

genetic factors (renin response, sodium channel polymorphism, etc)

evaluate family members; determine if genetic factor impacts the choice of medications


Antihypertensive drug combinations that often are effective include:

(1) angiotensin converting enzyme (ACE) inhibitor AND thiazide diuretic

(2) angiotensin converting enzyme (ACE) inhibitor AND calcium channel blocker (CCB)

(3) angiotensin receptor blocker (ARB) AND thiazide diuretic

(4) beta-adrenergic blocking agent AND thiazide diuretic


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