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Managing Hypertension and Associated Risk Factors Among African American Women

Managing Hypertension and Associated Risk Factors Among African American Women. Keith C. Ferdinand, MD Clinical Professor, Cardiology Division Emory University Chief Science Officer Association of Black Cardiologists, Inc. Atlanta, Georgia. High Blood Pressure.

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Managing Hypertension and Associated Risk Factors Among African American Women

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  1. Managing Hypertension and Associated Risk Factors Among African American Women Keith C. Ferdinand, MD Clinical Professor, Cardiology Division Emory University Chief Science Officer Association of Black Cardiologists, Inc. Atlanta, Georgia

  2. High Blood Pressure Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey, 1999-2002. Cited by American Heart Association. Available at: www.americanheart.org. Accessed July 19, 2007. *Applied to 2003 population estimates.

  3. Keys to Treating Hypertension in African American Patients • Focus on • Prevention • Assessment of individual risk profiles • Identification of high-risk patients • Early intervention • Combination therapy often may be required to achieve and maintain target BP Bakris et al. Postgrad Med online.2002;112.

  4. In African Americans, Some Barriers to Hypertension Control Are Physician Related • Lower outcomes expectations • Lack of specific clinical guidelines for treatment • Limited data to guide treatment decisions • Failure to treat early and aggressively and to target BP • Increased prevalence of comorbid disease requiring complex medical interventions Douglas JG, et al. Postgrad Med. 2002;112:51-52,55,59-62 passim.

  5. JNC 7: Considerations for Special Populations • In blacks, somewhat reduced BP responses to monotherapy with beta blockers, ACE inhibitors, or ARBs versus diuretics or CCBs • Adding adequate doses of a diuretic usually eliminates these differences JNC 7=Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; ACE=angiotensin-converting enzyme; ARBs=angiotensin receptor blockers; CCBs=calcium channel blockers. Chobanian AV, et al. JAMA. 2003;289:2560-2672.

  6. JNC 7: Multiple-Drug Therapy Is Frequently Necessary • Most patients with hypertension will require ≥2 medications to achieve goal BP • When BP is >20/10 mm Hg above goal, initial therapy with 2 drugs should be considered, including a thiazide-type diuretic Chobanian AV, et al. JAMA. 2003;289:2560-2672.

  7. Overweight and Obesity:Adults • In 2003, an estimated 136.5 million American adults were overweight; 64 million were obese • Since 1993, the prevalence of obesity has increased more than 61% • 20% of surveyed black women were obese by ages 18 to 24; by ages 25 to 44, more than 35% were obese • Overweight is associated with large decreases in life expectancy • Obesity was associated with nearly 112,000 excess deaths American Heart Association, American Stroke Association. Available at: www.americanheart.org. Accessed July 19, 2007. Thom T, et al. Circulation. 2006;113:e85-e151. Winkleby A, et al. Am J Health Promot. 2004;19:19-27. Peeters A, et al. Ann Intern Med. 2003;138:24-32. Flegal KM, et al. JAMA. 2005;293:1861-1867.

  8. Risk-Factor Clustering • In the BRFSS for 2001, 71.2% of African Americans reported having 1 or more risk factors • Most common 2-factor combination: Hypertension + Hypercholesterolemia • Most common 3-factor combination: Hypertension + Hypercholesterolemia + Obesity • Risk-factor clustering is more common in African Americans than in whites, especially for women • NHANES III (1988-1994): African American adults had the highest prevalence of 3 or more risk factors, almost 1 in 5 patients BRFSS=Behavioral Risk Factor Surveillance System (CDC); NHANES= National Health and Nutrition Examination Survey. Paynter N, et al. MMWR. 2004;53:4-7. Greenlund KJ, et al. Arch Intern Med. 2004;164:181-188. Sharma S, et al. Ethn Dis. 2004;14:43-48.

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