What are the Best Drugs and Combinations in Afro-Descendant Hypertensive Patients?

Abstract

Hypertension in African descendants occurs early, with high rates of cardiovascular events compared to Caucasians. In addition, genetic influence, low levels of plasma renin activity, greater sensitivity to salt, low sodium secretion, and other mechanisms are involved and discussed in this article. For pharmacological treatment, several studies were evaluated, such as CREOLE, ALLHAT, CARDIA, JHS, REGARDS, AASK, ACCOMPLISH, review articles and meta-analyzes and some guidelines, such as European, American, Brazilian to compare treatment indication. Several pharmacological classes, such as calcium channel blockers, Β-blockers, renin angiotensin system inhibitors, aldosterone and diuretics were included in present review in order to compare utilization and indication for Afro-descendant hypertensive patients. We concluded that several relevant points should be considered in the pharmacological treatment of African descendants that include pathophysiological characteristics, early development of lesions in target organs, in addition to higher rates of cardiovascular and renal events. In addition to lifestyle changes, improved nutrition, combined treatment, probably as a first-line treatment, should be considered as an approach, and the drugs used should aim at blood pressure control and inhibition of the inflammatory process, which results in worse outcomes. It is important to highlight that the representativeness of the Afro-descendant population was unsatisfactory for a robust conclusion. in this population, we can infer from the initial pharmacological treatment the use of thiazide-like diuretics, or dihydropyridine calcium channel blocker should be considered, although the institution of fixed combinations with angiotensin enzyme conversion inhibitors or angiotensin receptor blockers are important in the protection of target organs that occurs earlier and more seriously.