Population characteristics and the modulation of the renin-angiotensin system in the treatment of hypertension

Abstract

Clinical evidence supports the concept that there are racial differences in response to antihypertensive drugs. The high frequency of dietary salt sensitivity and low plasma renin activity (PRA) in hypertensives of African–American descent has been suggested by some to be the critical factor which explains this difference. Evaluation of the antihypertensive response of African–Americans to diuretics and calcium channel blockers compared to other drugs suggest that they may have an advantage in controlling blood pressure (BP). However, these comparative clinical trials have not assessed dietary salt consumption, the salt sensitivity status of the participants, nor have they explored full titration dosages of the comparative drugs. For these reasons, there is insufficient information to state with certainty whether some drugs may be more effective than others as monotherapy in controlling BP in hypertensives of African–American descent.