Making Noise about Hypertension and African Americans
People of all races and ethnic groups get high blood pressure, but it is an especially serious problem for African Americans.
We know that is true partly because of 30 years of work by Dr. Elijah Saunders.
Saunders is a professor at the University of Maryland Medical School in Baltimore and head of the hypertension section there.
His research has helped show that some blood pressure medications are more effective than others for African Americans. He helped start an organization called the International Society on Hypertension in Blacks.
Recently, the organization came up with guidelines telling doctors how they should treat high blood pressure in their African American patients, which is not always the same way it should be treated in whites. For example, many African Americans need to start on at least two medications to lower their blood pressure.
“Why waste time and effort prescribing just one drug when in most cases it won’t work?” asks Saunders.
Saunders was inspired to become a doctor by the example of Dr. Ralph Reckling, one of the doctors in the segregated west Baltimore neighborhood where he grew up.
When Saunders was a medical student in the late 1950s, doctors thought only people with extremely high blood pressure would benefit from treatment. “Extremely high” meant readings in the 200s and 300s. Blood pressure that high is called malignant hypertension.
The attitude about blood pressure started to change after the results of a study by the Veterans Administration were published in 1970. The study included people with what was then considered moderately high blood pressure. The results showed that lowering even moderately high levels lessens your risk of having a heart attack or stroke.
Those early studies didn’t include many African Americans, but others that came after did. Saunders worked to push the problem of African American hypertension into the spotlight.
“There was a lack of appreciation that this is a more serious problem in African Americans that needs to be treated aggressively,” he says. Saunders also co-wrote Hypertension in Blacks, the first thorough textbook on the subject. He researched blood pressure medications and found that drugs called calcium-channel blockers were more effective in African Americans than other drugs.
Hypertension is still a major problem for African Americans. Approximately 30 percent of adult African Americans have high blood pressure compared with approximately 22 percent of white adults.
But Saunders says progress has been made. More doctors are aware that they must pay extra close attention to the blood pressure of their black patients. Drug companies make a point of including African Americans in their studies. The federal government has paid for large studies of blood pressure medications, including one that cost about $100 million.
He notes, “A funded study like that would have never happened if it hadn’t been for the noise me and my colleagues made.”
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