Racial differences in antihypertensive therapy: evidence and implications.

Blood pressure is controlled by many factors, and thus hypertension is a multifactorial disorder. This etiologic diversity is also reflected in the broad spectrum of different pharmacologic agents known to lower blood pressure. Most carefully controlled studies employing a single antihypertensive drug in unselected, uncomplicated mild to moderate hypertensives demonstrate efficacy in reducing blood pressure in 40-60% of the population. If two agents of differing pharmacologic actions are combined, success rates of 70-90% are generally observed. Specific choices of antihypertensive agents have heretofore been based on whimsy, hearsay, or empiricism. More recent studies have identified characteristics that may help to predict the efficacy of single drugs. These characteristics have included physiologic factors, such as sodium sensitivity, plasma renin activity, or sympathetic nervous system activity, as well as demographic components, particularly age and race. This review will examine the effects of racial classification on the blood pressure response to antihypertensive agents.