Hypertension Management in African Americans: The AASK and Other Landmark Trial Application

Hypertension is a major public health challenge and affects 120 million adults in the United States. Recent hypertension trial outcomes indicate that further lowering of blood pressure below the standard target may reduce mortality (Group et al., N Engl J Med 373(22):2103–2116, 2015) which is now reflected in the latest treatment guidelines that have lowered the target blood pressure to 130/80 mmHg (Whelton et al., Hypertension 71:e13–e115, 2018). The excess burden of hypertension among African-Americans was recognized in the early twentieth century and largely contributes to the excessive morbidity and mortality seen in this population compared to other racial/ethnic groups. It is well documented that hypertension in African-Americans is more prevalent, has an earlier onset, increased severity and results in more complications than other populations (Flack et al., Curr Cardiol Rep 14(6):660–666, 2012). Despite treatment advances, improved access to health care, and similar control rates across most racial groups, African-Americans continue to experience high rates of hypertension attributable complications such as end stage renal disease (ESRD), heart failure and stroke. A comprehensive approach for effective management of hypertension in the African-American population is crucial to address this important health disparity. The pathogenesis, new hypertension guidelines and clinical trial outcomes related to African-Americans, specifically the African American Study of Kidney Disease and Hypertension (AASK) trial, will be discussed in this chapter. The term “African-American” or “Black” patients will refer to all people of African ancestry living in the USA.