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ISHIB Offers Guidelines for Treating Hypertension in African Americans
by Pam Chwedyk Minority Nurse Writer
According to the International Society on Hypertension in Blacks (ISHIB), African Americans are significantly more likely to die from high blood pressure than the general public. Yet until now, no clinical guidelines have been available to assist health care professionals in developing HBP treatment strategies targeted to the special needs of this vulnerable, high-risk population.
To close this deadly information gap, ISHIB convened a panel of 16 prominent hypertension experts to develop the first-ever guidelines for treating and managing high blood pressure in African Americans. These benchmark recommendations, published in March in the Archives of Internal Medicine, have been endorsed by the American Heart Association, the National Medical Association, the Association of Black Cardiologists and other leading medical organizations.
The ISHIB guidelines urge physicians and nurses to adopt four key strategies:
Recognize that many black patients will need to start on at least two medications—such as combinations of ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers or diuretics—to successfully lower their blood pressure. ISHIB recommends using the “15 over 10” rule: Any patient with a systolic BP of 15 mm Hg or more above the desired goal and a diastolic BP equal to or greater than 10 mm Hg above the goal should start on two drugs instead of one.
Lower the target blood pressure goal for African Americans who have heart disease, kidney disorders or diabetes. Specifically, ISHIB calls for a more aggressive target of 130/80 mm Hg for black patients with these conditions, rather than the previous standard of 140/90 mm Hg (for most patients) and 130/85 Hg (for diabetics) recommended in 1997 by the federal government.
Treat hypertensive black patients who have diabetes with medications that have been shown to slow the progression of kidney disease—such as ACE inhibitors or ARBs—as part of their combination therapy.
Urge patients to make lifestyle modifications, such as engaging regularly in appropriate exercise, limiting their alcohol intake and avoiding tobacco. ISHIB also endorses the Dietary Approaches to Stop Hypertension (DASH) diet, which clinical studies have shown to be very effective in lowering blood pressure, especially in African Americans.
Nurses can obtain the full text of the new guidelines by contacting ISHIB at (404) 875-6263 or visiting www.ishib.org.