Skip to main content
SpringerLink
Log in

Important Differences in Cardiovascular Care

  • Chapter
  • First Online:
Download book PDF
Download book EPUB
Patient-Centered Clinical Care for African Americans

  • 1290 Accesses

Abstract

There are a number of important differences in the care of African Americans that can substantially impact clinical outcomes including specific medication choices, disease control, and alternative clinical approaches. Applying these research-verified clinical management regimes can assuredly clear a more efficient path to clinical success and positively benefit outcomes. For example, hypertension therapy should be initiated with a thiazide-type diuretic or a calcium channel blocker which have been proven to have better blood pressure reduction, and are better at preventing cardiovascular events. ACE inhibitors are less effective at reducing blood pressure and should not be used as monotherapy unless the patient has diabetes with proteinuria. African Americans have more favorable lipid profiles but with disproportionately higher cardiovascular disease. Because of this, clinicians should have a lower threshold for cardiovascular prophylaxis. African Americans have a decreased risk for atrial fibrillation and because of the increased risk for stroke, this is referred to as a “racial paradox.” Other cardiovascular recommendations beneficial to African Americans are reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. 2015 National Healthcare Quality and Disparities Report Chartbook on Health Care for Blacks. Rockville: Agency for Healthcare Research and Quality; 2016. AHRQ Pub. No 16-0015-1-EF.

    Google Scholar 

  2. Carnethon M, Pu J, Aalbert M, et al. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation. 2017;136:e393–423.

    PubMed  Google Scholar 

  3. Cooper R, Wolf-Maier K, et al. An international comparative study of blood pressure in populations of European vs. African descent. BMC Med. 2005;3:2.

    PubMed  PubMed Central  Google Scholar 

  4. Benjamin E, Blaha M, Chiuve S, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146–603.

    PubMed  PubMed Central  Google Scholar 

  5. Young D, Fischer H, Arterburn D, et al. Associations of overweight/obesity and socioeconomic status with hypertension prevalence across racial and ethnic groups. J Clin Hypertens (Greenwich). 2018;20(3):532–40.

    CAS  Google Scholar 

  6. Williams J, Chamarthi B, Goodarzi M, et al. Lysine-specific demethylase 1: an epigenetic regulator of salt-sensitive hypertension. Am J Hypertens. 2012;25(7):812–7.

    CAS  PubMed  Google Scholar 

  7. Richardson S, Freedman B, Ellison D, et al. Salt sensitivity: a review with a focus on non-Hispanic blacks and Hispanics. J Am Soc Hypertens. 2013;7(2):170–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Wright J, Rahman M, et al. Determinants of salt sensitivity in black and white normotensive and hypertensive women. Hypertension. 2003;42:1087–92.

    CAS  PubMed  Google Scholar 

  9. Gates P, Tanaka H, Hiatt W, et al. Dietary sodium restriction rapidly improves large elastic artery compliance in older adults with systolic hypertension. Hypertension. 2004;44:35–41.

    CAS  PubMed  Google Scholar 

  10. Todd A, Macginley R, Schollum J, et al. Dietary salt loading impairs arterial vascular reactivity. Am J Clin Nutr. 2010;91:557–64.

    CAS  PubMed  Google Scholar 

  11. Jin Y, Kuznetsova T, Maillard M, et al. Independent relations of left ventricular structure with the 24-hour urinary excretion of sodium and aldosterone. Hypertension. 2009;54:489–95.

    CAS  PubMed  Google Scholar 

  12. Rodriguez CJ, Bibbins-Domingo K, Jin Z, et al. Association of sodium and potassium intake with left ventricular mass: coronary artery risk development in young adults. Hypertension. 2011;58:410–6.

    CAS  PubMed  Google Scholar 

  13. Swift PA, Markandu ND, Sagnella GA, et al. Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: a randomized control trial. Hypertension. 2005;46:308–12.

    CAS  PubMed  Google Scholar 

  14. Stocker SD, Monahan KD, Browning KN. Neurogenic and sympatho-excitatory actions of NaCl in hypertension. Curr Hypertens Rep. 2013;15:538–46.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Parati G, Ochoa JE, Lombardi C, et al. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013;10:143–55.

    PubMed  Google Scholar 

  16. He F, Li J, Macgregor G. Effect of longer term modest salt reduction on blood pressure: cochrane systematic review and meta-analysis of randomized trials. BMJ. 2013;346:f1325.

    PubMed  Google Scholar 

  17. Wright J, Probstfield JJ, Cushman W, et al. ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses. Arch Intern Med. 2009;169(9):832–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2018;71(6):1269–324.

    CAS  Google Scholar 

  19. Wright J, Williams J, Whelton P, SPRINT Research Group, et al. A randomized trial of intensive versus standard blood pressure control. N Engl J Med. 2015;373(22):2103–16.

    CAS  PubMed  Google Scholar 

  20. Williamson J, Supiano M, Applegate W, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA. 2016;315:2673–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Still C, Rodriguez C, Wright J, et al. Clinical outcomes by race and ethnicity in the systolic blood pressure intervention trial (SPRINT): a randomized clinical trial. Am J Hypertens. 2017;31(1):97–107.

    PubMed  PubMed Central  Google Scholar 

  22. Muacevic A, Adler J, Asad A, et al. American Heart Association high blood pressure protocol 2017: a literature review. Cureus. 2018;10(8):e3230.

    Google Scholar 

  23. Wright J, Dunn J, Cutler J, et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. 2005;293(13):1595–608.

    CAS  PubMed  Google Scholar 

  24. Materson B, Reda D, Cushman W, et al. Single-drug therapy for hypertension in men – a comparison of six antihypertensive agents with placebo. N Engl J Med. 1993;328:914–21.

    CAS  PubMed  Google Scholar 

  25. Trunbull F. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials. Lancet. 2003;362(9395):1527–35.

    Google Scholar 

  26. Bangalore S, Ogedegbe G, Gyamfi J, et al. Outcomes with angiotensin-converting enzyme inhibitors vs other antihypertensive agents in hypertensive blacks. Am J Med. 2015;128(11):1195–203.

    CAS  PubMed  Google Scholar 

  27. National Clinical Guideline Centre. Hypertension: the clinical management of primary hypertension in adults: update of clincal guidlines 18 and 34. London: Royal College of Physicians (UK) - National Clinical Guideline Centre; 2011.

    Google Scholar 

  28. Williams S, Nicholas S, Vaziri N, Norris K. African Americans, hypertension and the renin angiotensin system. World J Cardiol. 2014;6(9):878–89.

    PubMed  PubMed Central  Google Scholar 

  29. Rizos C, Elisaf M. Antihypertensive drug therapy in patients with African ancestry. Expert Opin Pharmacother. 2014;15(8):1061–4.

    CAS  PubMed  Google Scholar 

  30. Yazdanshenas H, Bazargan M, Orum G, et al. Original reports: cardiovascular disease and risk factors. prescribing patterns in the treatment of hypertension among underserved African American elderly. Ethn Dis. 2014;24(4):431–7.

    PubMed  Google Scholar 

  31. Scisney-Matlock M, Bosworth H, Giger J, et al. Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans. Postgrad Med. 2009;121(3):147–59.

    PubMed  PubMed Central  Google Scholar 

  32. Lanfear D, Hrobowski T, Peterson E, et al. Association of beta blocker exposure with outcomes in heart failure patients differs between African American and white patients. Circ Heart Fail. 2012;5(2):202–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Cohn J, Archibald D, Francis G, et al. Veterans administration cooperative study on vasodilator therapy of heart failure: influence of prerandomization variables on the reduction of mortality by treatment with hydralazine and isosorbide dinitrate. Circulation. 1987;75(5 Pt 2):IV49–54.

    CAS  PubMed  Google Scholar 

  34. Cohn J, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991;325:303–10.

    CAS  PubMed  Google Scholar 

  35. Yancy C, Jessup M, Bozkurt B, et al. ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Circulation. 2017;136:e137–61.

    PubMed  Google Scholar 

  36. Cardillo C, Kilcoyne C, Cannon R, et al. Racial differences in nitric oxide-mediated vasodilator response to mental stress in the forearm circulation. Hypertension. 1998;31:1235–9.

    CAS  PubMed  Google Scholar 

  37. Stein C, Lang C, Nelson R, Brown M, Wood A. Vasodilation in black Americans: attenuated nitric oxide-mediated responses. Clin Pharmacol Ther. 1997;62(4):436–43.

    CAS  PubMed  Google Scholar 

  38. Yancy C, Abraham W, Albert N, et al. Quality of care of and outcomes for African Americans hospitalized with heart failure: findings form the OPTIMIZE-HF registry. J Am Coll Cardiol. 2008;51(17):1675–84.

    PubMed  Google Scholar 

  39. Krim S, Vivo R, Krim N, et al. Racial/ethnic differences in B-type natriuretic peptide levels and their association with care and outcomes among patients hospitalized with heart failure: findings from get with the guidelines–heart failure. JACC Heart Fail. 2013;1(4):345–52.

    PubMed  Google Scholar 

  40. Bajaj N, Gutierrez O, Arora G, et al. Racial differences in plasma levels of N-terminal pro-B-type natriuretic peptide and outcomes: the reasons for geographic and racial differences in stroke (REGARDS) study. JAMA Cardiol. 2018;3(1):11–7.

    PubMed  Google Scholar 

  41. Bentley A, Rotimi C. Inter-ethnic variation in lipid profiles: implications for under-identification of African Americans at risk for metabolic disorders. Expert Rev Endocrinol Metab. 2012;7(6):659–67.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Pan Y, Pratt C. Metabolic syndrome and its association with diet and physical activity in US adolescents. J Am Diet Assoc. 2008;108(2):276–86.

    PubMed  Google Scholar 

  43. Furtado J, Campos H, Summer A, Appel L, Cary V, Sacks F. Dietary interventions that lower lipoproteins cantaining apolipoprotein C-III are more effective in whites than in blacks: results of the OmniHeart trial. Am J Clin Nutr. 2010;92(4):714–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Amponash M, Benjamin E, Magnani J. Atrial fibrillation and race – a contemporary review. Curr Cardiovasc Risk Rep. 2013;7(5):336. https://doi.org/10.1007/s12170-013-0327-8.

    Article  Google Scholar 

  45. Meschia J, Soliman M, Soliman E, et al. Racial disparities in awareness and treatment of atrial fibrillation: the reasons for geographic and racial differences in stroke (REGARDS) study. Stroke. 2010;41(4):581–7.

    PubMed  PubMed Central  Google Scholar 

  46. Marini C, De Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke. Stroke. 2005;36:1115–9.

    PubMed  Google Scholar 

  47. Roger V, Go A, Lloyd-Jones D, et al. Heart disease and stroke statistics – 2012 update. Circulation. 2012;125(1):e2–e220.

    PubMed  Google Scholar 

  48. Qian F, Fonarow G, Smith E, et al. Racial and ethnic differences in outcomes in older patients with acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2013;6(3):284–92.

    PubMed  Google Scholar 

  49. Chiou-Tan F, Keng M, Graves D, Chan K, Rintala D. Racial/ethnic differences in FIM scores and length of stay for underinsured patients undergoing stroke inpatient rehabilitation. Am J Phys Med Rehabil. 2006;85(5):415–23.

    PubMed  Google Scholar 

  50. U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/.

  51. African American Health. Vital signs. Centers for Disease Control and Prevention. 2017. Accessed 9 May 2019.

    Google Scholar 

  52. Bell E, Lutsey P, Basu S, et al. Lifetime risk of venous thromboembolism in two cohort studies. Am J Med. 2016;129(3):339.e19–26.

    Google Scholar 

  53. Rowe VL, Weaver FA, Lane JS, Etzioni DA. Racial and ethnic differences in patterns of treatment for acute peripheral arterial disease in the United States, 1998–2006. J Vasc Surg. 2010;51:21S–6S.

    PubMed  Google Scholar 

  54. Durazzo TS, Frencher S, Gusberg R. Influence of race on the management of lower extremity ischemia: revascularization vs amputation. JAMA Surg. 2013;148:617–23. https://doi.org/10.1001/jamasurg.2013.1436.

    Article  PubMed  Google Scholar 

  55. Mustapha J, Fisher B, Rizzo J, et al. Explaining racial disparities in amputation rates for the treatment of peripheral artery disease (PAD) using decomposition methods. J Racial Ethn Health Disparities. 2017;4(5):784–95.

    PubMed Central  Google Scholar 

  56. Clark D, Cain L, Blaha M, et al. Cigarette smoking and subclinical peripheral arterial disease in blacks of the Jackson heart study. J Am Heart Assoc. 2019;8:e010674.

    PubMed  PubMed Central  Google Scholar 

  57. Payne A, Miller C, Hooper W, Lally C, Austin H. High factor VIII, von Willebrand factor, and fibrinogen levels and risk of venous thromboembolism in blacks and whites. Ethn Dis. 2014;24(2):169–74.

    PubMed  Google Scholar 

  58. Bolorunduro O, Kiladejo A, Animashaun I, Akinboboye O. Disparities in revascularization after ST elevation myocardial infarction (STEMI) before and after the 2002IOM report. J Natl Med Assoc. 2016;108(2):119–23.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Partnerships for Urban Health, Cleveland State University, Cleveland, OH, USA

    Gregory L. Hall MD

Authors
  1. Gregory L. Hall MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hall, G.L. (2020). Important Differences in Cardiovascular Care. In: Patient-Centered Clinical Care for African Americans. Springer, Cham. https://doi.org/10.1007/978-3-030-26418-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26418-5_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26417-8

  • Online ISBN: 978-3-030-26418-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation