African Americans hypertension

A high percentage of patients who take clonidine (up to 38%) (34) develop contact allergic reactions, usually due to the active ingredient, at the patch application site (35). This has been reported with a frequency of 15% in 357 African-American hypertensive patients. It can lead to drug discontinuation in 4.2% of patients. 

In the United States, African-Americans are twice as likely as Caucasians to experience hypertension. After age 65 years, African-American women have the highest incidence of hypertension. Essential hypertension cannot be cured but can be controlled. Many individuals experience hypertension as they grow older, but hypertension is not a part of healthy aging. For many older individuals, the systolic pressure gives the most accurate diagnosis of hypertension. Display 42-2 discusses the importance of the systolic pressure ... 

The prevalence of hypertension differs based on age, sex, and ethnicity. As individuals become older, their risk of high blood pressure increases. Individuals 55 years of age who do not have hypertension are estimated to have a lifetime risk of 90% of eventually developing hypertension. The National Health and Nutrition Examination Survey from 1999 to 2000 indicated that hypertension is slightly more prevalent in men (30.1%) than women (27.1%). However, the prevalence increased by 5.6% in women and has remained unchanged in men from 1988 to 2000.5 Hypertension prevalence is highest in African-Americans when compared to non-Hispanic whites and Mexican-Americans.1... 

JT, a 55-year-old African-American woman, comes to your clinic with a recent diagnosis of hypertension. She is 5 5"... 

Patients with asymptomatic left ventricular systolic dysfunction and hypertension should be treated with P-blockers and ACE inhibitors. Those with heart failure secondary to left ventricular dysfunction and hypertension should be treated with drugs proven to also reduce the morbidity and mortality of heart failure, including P-blockers, ACE inhibitors, ARBs, aldosterone antagonists, and diuretics for symptom control as well as antihypertensive effect. In African-Americans with heart failure and left ventricular systolic dysfunction, combination therapy with nitrates and hydralazine not only affords a morbidity and mortality benefit, but may also be useful as antihypertensive therapy if needed.66 The dihydropyridine calcium channel blockers amlodipine or felodipine may also be used in patients with heart failure and left ventricular systolic dysfunction for uncontrolled blood pressure, although they have no effect on heart failure morbidity and mortality in these patients.49 For patients with heart failure and preserved ejection fraction, antihypertensive therapies that should be considered include P-blockers, ACE inhibitors, ARBs, calcium channel blockers (including nondihydropyridine agents), diuretics, and others as needed to control blood pressure.2,49... 

Non-modifiable risk factors include age, gender, race/ ethnicity, and heredity. Ischemic stroke risk is increased in those greater than 55 years of age, in men, and in African-Americans, Hispanics, and Asian-Pacific Islanders. It is also increased in those with a family history of stroke. Modifiable risk factors include a number of treatable disease states and lifestyle factors that can greatly influence overall stroke risk. Hypertension is... 

GR is a 68-year-old African-American male who presents to the emergency department with dizziness and loss of speech that began 1 hour ago. His past medical history is significant for hypertension, diabetes mellitus, hypercholesterolemia, and benign prostatic hypertrophy (BPH). Social history is significant for smoking 1 pack per day for the last 38 years. Current medications include metoprolol 50 mg twice daily, insulin NPH 20 units twice daily, and simvastatin 20 mg daily. 

A 57-year-old African-American man presents to the clinic for follow-up management of UC. He has had left-sided disease for 3 years and has been maintained in remission on maximal doses of oral mesalamine and prednisone 35 mg orally once daily. His provider has attempted several times to taper the prednisone dose, but the patient experiences a reappearance of symptoms if the dose is lowered below this level. Medical history is also significant for hypertension and heart failure. He has no known drug allergies. 

Because of the slow onset of CKD and the lack of symptoms in earlier stages, the prevalence of CKD is difficult to determine until patients reach ESRD. It is estimated that approximately 19 million people (11% of the United States population) have some degree of CKD.2 Approximately 8 million people have a GFR less than 60 mL/minute/1.73 m2,2 at which point CKD is generally diagnosed as a clinical condition. The prevalence of CKD is correlated with specific demographic factors increased age, African-American race, and hypertension. 

A 65-year-old African-American female with a history of diabetes, mild intermittent asthma, and hypertension presents to your clinic for her yearly check-up. She states that she is concerned about losing her eyesight because her sister has started losing her vision from glaucoma. She states that she has not noticed any changes in her vision. 

Cardiovascular Effects. There is currently considerable scientific debate as to whether there is a causal relationship between lead exposure and hypertension. Another area of controversy is whether African Americans are more susceptible to the cardiovascular effects of lead than are whites or Hispanics. The evidence from both occupational studies and large-scale general population studies (i.e., National Health and Nutrition Examination Survey [NHANES II], British Regional Heart Study [BRHS]) is not sufficient to conclude that such a causal relationship exists between PbB levels and increases in blood pressure. The database on lead-induced effects on cardiovascular function in humans will be discussed by presenting a summary of several representative occupational studies followed by a discussion of the findings from the large-scale general population studies. 

Duru K, Farrow S, Wang J-M, Lock-ette W, Kurz T. Frequency of a deletion polymorphism in the gene for angiotensin converting enzyme is increased in African-Americans with hypertension. 

Hypertension is more common and more severe in African Americans than in those of other races. Differences in electrolyte homeostasis, glomerular filtration rate, sodium excretion and transport mechanisms, plasma renin activity, and BP response to plasma volume expansion have been noted. 

Feelings of isolation were common among interviewees at both historically black colleges and universities and historically white colleges and universities. In instances where the chemists were the only persons of color in the department or perhaps the first ones ever appointed to a faculty position in chemistry, many became discouraged and sometimes very depressed. Benjamin (1991) posits that the social isolation faced by many upwardly mobile African Americans often leads to stress, which can manifest itself in physiological disorders, such as hypertension, behavioral disorders, and even suicide. One Cohort V interviewee offered the following comments ... 

Hydralazine, a hydrazine derivative, dilates arterioles but not veins. It has been available for many years, although it was initially thought not to be particularly effective because tachyphylaxis to its antihypertensive effects developed rapidly. The benefits of combination therapy are now recognized, and hydralazine may be used more effectively, particularly in severe hypertension. The combination of hydralazine with nitrates is effective in heart failure and should be considered in patients with both hypertension and heart failure, especially in African-American patients. 

Hypertension is a sustained, reproducible increase in blood pressure. Hypertension is one of the most common diseases affecting adults living in industrialized nations. In the United States, for example, hypertension occurs in approximately 30% of the general population aged 20 and over.44 The prevalence of this disease can be even higher in certain subpopulations (e.g., 41% in African Americans), and the incidence of hypertension increases with age.44,45 If left untreated, the sustained increase in blood pressure associated with hypertension can lead to cardiovascular problems (stroke, heart failure), renal disease, and blindness.15,22 108 111 These and other medical problems ultimately lead to an increased mortality rate in hypertensive individuals. 

El-Gharbawy, A. H., Kotchen, J. M., Grim, C. E., Kaldunski, M., Hoffmann, R. G., Pausova, Z., Hamet, P., and Kotchen, T. A. 2002. Gender-specific correlates of leptin with hypertension-related phenotypes in African Americans. Am. J. Hypertens. 15 989-993. 

On the other hand, some diseases for which African Americans are at greater risk, such as hypertension and stroke, may be made worse by a low intake of calcium. Average intake of calcium in African American, Hispanic, and Asian populations are at the threshold (600-700 mg/day) below which bone loss and hypertension can result. Though many members of these groups are lactase nonpersistent, intolerance symptoms can be reduced to acceptable levels with commonsense dietary practices that still allow sufficient intake of dairy products for health. Partial reduction of national health disparities between ethnic groups may be possible by overcoming the barrier of lactose intolerance (Jarvis and Miller, 2002). 

Douglas J, Greene TH, Toto RD et al. (2002) The African-American Study of Kidney Disease and Hypertension (AASK Trial). Journal of the American Society of Nephrology 13 1 31 P. 

CCT as a Function of Race, Age, and Disease. Average CCT varies with race (Box 34-1), age, and diagnosis. Whites, Chinese, Hispanics, and Filipinos tend to have comparable CCTs. Among the Asian races, Mongolians have the thinnest CCT, whereas the Japanese have thinner corneas than Chinese and Filipinos. African-Americans, patients with glaucoma, and older patients tend to have thinner corneas. Patients with ocular hypertension tend to have thicker corneas. 

The statistics are staggering. One-third of Americans over the age of eighteen—65 million—have at least mild hypertension. For African American women, it s half the population, and for black men it s a major problem as well. At least one-third of people with high blood pressure are not being treated. That means millions and millions of men and women are at risk for a heart attack or a stroke. 

The following numbers speak for themselves, and I present them without commentary or fearmongering. Statistics from the American Heart Association in 2006 show that 65 million men and women in the United States have high blood pressure, defined as systolic pressure of 140 or greater and/or diastolic pressure of 90 or more. In the white population, 20.5 percent have hypertension, while that percentage jumps to 31.6 for African Americans. Nineteen percent of Hispanics and 16.1 percent of Asians have hypertension. 

The correlation between race and hypertension goes beyond medical and/or physiological explanations. It appears that racism itself has been shown to increase blood pressure in African Americans. That racism, according to researchers at Duke University in... 

The solution to the problem may well be more social than medical. In a project based at Johns Hopkins University in Baltimore, 309 urban African Americans participated in a program that included job referrals, career training, and housing assistance. At the end of a three-year period, the men who were part of the program had significantly better control of their hypertension than did those who did not participate. 

But Dr. Marton also noted that these results do not rule out the possibility that an individual patient occasionally will have a more substantial response to salt restriction. Such individuals are most likely to be African American, overweight, older, and hypertensive, since these men and women are more often salt sensitive. And data reported in 2005 from the University of Miami in Florida indicate that women may become more salt sensitive as they enter their postmenopausal years. 

Race—African-American Genetic Modifiable Hypertension Diabetes. Smoking Atrial fibrillation Coronary arter y disease Prior sb oke... 

Ssalt-sensitive people tend to develop hypertension with an intake of 125 to 250 mmol of Na per day, whereas salt-resistant people may not have a rise in blood pressure with up to 500 irunol of Na per day. Very large amounts of Na (800 mmol/day) lead to hypertension in both salt-sensitive and -insensitive people. It has been estimated that close to 20% of adult Americans lire salt sensitive. African-Americans have a greater incidence of Na sensitivity and hypertension than Americans of European descent. Generally, blood pressure tends to increase with age in salt-sensitive individuals consuming mrrderate or high levels of sodium. The prevalence of hypertension is very low in children and adolescents. The interracial differences in blood pressure that are found in adults arc not found among children (Sinaiko, 1996). 

Dias VC, Tendler B, Oparil S, Reilly PA, Snarr P, White WB. Clinical e.xperience with transdermal clonidine in African-American and Hispanic-American patients tvith hypertension evaluation from a 12-week prospective, open-label clinical trial in community-based clinics. Am J Ther 1999 6(l) 19-24. 

In a study of the efficacy and safety of sibutramine in obese white and African Americans with hypertension, the most common adverse event resulting in withdrawal... 

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