Hypertension is the most commonly diagnosed and treated chronic condition in the outpatient setting. High blood pressure is a powerful risk for cardiovascular and renal disease and is disparate in US blacks in prevalence and complications. This text is designed to highlight important epidemiological data, target organ manifestations, and the evidence basis for potentially the most effective means to prevent and control this deadly condition in African Americans.
Nevertheless, the optimal approach to developing best practices must entail more than a recitation of recent guidelines. While graded, evidence-based guidelines are necessary to identify optimal treatment of patients, in most circumstances clinicians also remain appreciative of the viewpoints of experts in this field. These opinions add to and supplement guidelines, which are actually never assumed to be a replacement for clinical judgment. In the final analysis, patient care must be applied on a one-on-one approach, reflecting the unique circumstances presented by that patient. As a result, especially considering the often-insufficient inclusion of African Americans and other racial/ethnic minorities in many large randomized clinical trials, while clinicians must hopefully utilize outcome evidence to guide therapy, the expert opinions contained in this text also may assist in treating their high-risk African American patients. Hence, understanding the concepts in this compendium for effective treatment of hypertension in African Americans is a necessary step to decreasing and eventually eliminating disparities in cardiovascular diseases.
In the final analysis, this dual approach may best curtail the unfortunate and unnecessary premature morbidity and mortality due to hypertension prevalence in blacks and associated cardiorenal metabolic and atherosclerotic cardiovascular disease (CVD) events. New Orleans, LA, USA Keith C. Ferdinand, MD, FACC, FAHA, FASH, FNLA

1 Overview 1

2 Epidemiology Awareness, Prevalence, and Control: Newest Findings on Hypertension in Blacks 21

3 Therapeutic Lifestyle Changes to Decrease Unhealthy Eating Patterns and Improve Blood Pressure in African Americans 35

4 Community Programs for Hypertension: A Means of Identification and Intervention in the Highest-Risk Population 59

5 Stroke and Hypertension in High-Risk African Americans 71

6 Manifestations of Left Ventricular Hypertrophy and Coronary Heart Disease: The Contribution of Hypertension and the Paradox in Blacks 95

7 Heart Failure Morbidity, Mortality, and Its Relationship to Hypertension 111

8 Hypertension and Atrial Fibrillation in African Americans 123

9 Cardiorenal Metabolic Syndrome and Diabetes in African Americans: Adding to the Risk of Hypertension 137

10 Central Aortic Pressure, Arterial Compliance: Emerging Tools to Identify and Guide Therapy for High-Risk African American Patients 151

11 Renal Denervation Therapy and Baroreceptor Activation Therapy: Emerging Tools for Treating Resistant Hypertension 163

12 Practical Approaches to Promote Adherence and Improve Blood Pressure Control in Black Patients 185

13 Integration of a Team Approach to Hypertension Treatment 199

14 Practical Pearls in the Treatment of Hypertension in Blacks 213

15 Hypertension in African Americans 233

16 New Guideline Recommendations on Hypertension: Preventing CVD and Renal Disease with Applications to Blacks 251

Index 271

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