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USC cardiologist helps set new blood pressure guidelines

A Keck School of Medicine cardiologist has helped create new national guidelines that back earlier and more aggressive, consistent treatment for African Americans with high blood pressure.

L. Julian Haywood, professor of cardiovascular medicine at the Keck School, served on a panel of 16 medical experts convened by the International Society on Hypertension in Blacks, or ISHIB. The panel published its recommendations in the March 10 issue of Archives of Internal Medicine.

High blood pressure contributes to numerous health problems that hit African Americans especially hard: About 40 percent of African Americans have cardiovascular disease and 13 percent have diabetes, while nearly a third of all people on dialysis due to kidney failure are African-American. Each year, cardiovascular disease accounts for 37 percent of the nearly 286,000 African Americans who die.

Because African Americans are more likely than the general public to die of a disease linked to high blood pressure, ISHIB wanted leading medical experts to come up with strategies to improve treatment and potentially save lives.

In its paper, the physician panel provided a practical guide for doctors, nurse practitioners and other caregivers to create and follow individualized blood-pressure-lowering plans for each patient. The panel issued these recommendations:

o Physicians should set a blood pressure goal of less than 130/80 mm Hg for African-American patients with cardiovascular disease, kidney disease or diabetes; the federal government set the standard at 140/90 mm Hg for most patients and 130/85 mm Hg for patients with diabetes in 1997. Optimal blood pressure is 120/80 mg Hg or lower.

o African-American patients whose systolic blood pressure (the first number in a blood pressure reading) is 15 mm Hg above the goal or whose diastolic blood pressure (the second number) is 10 mm Hg above the goal need to start on at least two medications to successfully lower their blood pressure.

o African Americans with diabetes should get medications that have been proven to slow progression of kidney disease, such as ACE inhibitors or angiotension II receptor blockers, or ARBs, as part of their treatment regimen.

Haywood served on the steering committee for the recently completed Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, or ALLHAT, which showed that many African-American patients need two or more drugs to reach a healthy blood pressure level and reduce risk of heart attacks, strokes and kidney disease. He also directed the ALLHAT study site at LAC+USC Medical Center.

When more than one medication is needed, the panel recommended that physicians prescribe low doses of medication from two different classes, including ACE inhibitors, ARBs, calcium channel blockers or diuretics.

The group recommended that physicians encourage patients to adopt a heart-healthy lifestyle to lower risk, too.

They suggested a realistic program of fun activities and moderate exercise—from dancing or walking to tennis or jogging—and recommended moderating alcohol and salt consumption and avoiding tobacco. They also suggested following the Dietary Approaches to Stop Hypertension, or DASH diet, which is rich in fruit, vegetables and fibers and emphasizes low-fat dairy foods, meat and poultry.

(For information about this diet, go to www.nhlbi.nih.gov/health/public/heart/hbp/dash/ .)

The panel, called the Hypertension in African Americans Working Group, convened in 2001 to define needs for guidelines on blood pressure control specific to African Americans.

For more information about African Americans and hypertension, go to www.ishib.org. ISHIB is a nonprofit medical society that aims to improve the health and life expectancy of ethnic populations around the world.

The effort also was supported by an unrestricted grant from Novartis International AG.

Janice G. Douglas, George L. Bakris, Murray Epstein, et al., “Management of High Blood Pressure in African Americans,” Archives of Internal Medicine. Vol. 163, No. 5, March 2003, pp. 525-541.

USC cardiologist helps set new blood pressure guidelines

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