Optimizing hypertension and vascular health: focus on ethnicity.

Black individuals are at significantly higher risk for hypertension and its sequelae, including end-stage renal disease and congestive heart failure, compared with other ethnic groups. The reason for this increased risk is likely multifactorial: although genetic differences may play a partial role in the etiology and pathophysiology of hypertension in black patients, factors related to lifestyle, most notably high body mass index, appear to have a greater impact. The treatment approach to lowering blood pressure in blacks is the same as for other ethnic groups. Patients should be aggressively managed, using combination therapies in the majority of them to achieve optimal blood pressure control and thereby cardiorenal protection. Although blockers of the renin-angiotensin system (RAS) appear to be less effective for lowering blood pressure and preventing kidney disease in blacks compared with whites, black patients have been underrepresented in studies of RAS blockers. Calcium channel blockers are distinctive for their potent blood pressure-lowering effects, and novel strategies such as chronotherapeutic dosing of these agents has further improved upon the flexibility of their use.