Published online Sep 26, 2014. doi: 10.4330/wjc.v6.i9.878
Revised: June 28, 2014
Accepted: July 15, 2014
Published online: September 26, 2014
Processing time: 246 Days and 15.7 Hours
African Americans have exceptionally high rates of hypertension and hypertension related complications. It is commonly reported that the blood pressure lowering efficacy of renin angiotensin system (RAS) inhibitors is attenuated in African Americans due to a greater likelihood of having a low renin profile. Therefore these agents are often not recommended as initial therapy in African Americans with hypertension. However, the high prevalence of comorbid conditions, such as diabetes, cardiovascular and chronic kidney disease makes treatment with RAS inhibitors more compelling. Despite lower circulating renin levels and a less significant fall in blood pressure in response to RAS inhibitors in African Americans, numerous clinical trials support the efficacy of RAS inhibitors to improve clinical outcomes in this population, especially in those with hypertension and risk factors for cardiovascular and related diseases. Here, we discuss the rationale of RAS blockade as part of a comprehensive approach to attenuate the high rates of premature morbidity and mortality associated with hypertension among African Americans.
Core tip: African Americans have exceptionally high rates of hypertension and hypertension related complications. Due to a greater likelihood of having a low plasma renin levels, inhibitors of the renin angiotensin system (RAS) are often not recommended as initial antihypertensive therapy. However, animal models suggest hypertension characterized by low circulating renin levels have a paradoxical increase in tissue RAS activity. Thus treatment with RAS inhibitors may be critical to preventing end organ damage. We describe the rationale of RAS blockade as part of a comprehensive approach to attenuate the high rates of premature morbidity and mortality associated with hypertension among African Americans.