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Diuretics are among the most effective drugs available for controlling blood pressure, especially among black Americans, and they happen to be relatively inexpensive, too. For black Americans whose blood pressure does not respond to diuretics alone, studies have shown the benefits of combining diuretics with other blood pressure medications, such as ACE inhibitors or beta blockers. Neither ACE inhibitors nor beta blockers seem to be as effective for black Americans when taken alone. However, ACE inhibitors are effective among black Americans suffering from kidney failure or heart failure in addition to high blood pressure.
Other medications that may be prescribed include calcium channel blockers (which are more expensive but are effective if diuretics cannot be tolerated) and cholesterol-reducing drugs. To reduce the risk of stroke, anticoagulants or antiplatelets may also be prescribed because they help to prevent the formation of blood clots.
In addition to taking blood pressure medication, black American hypertensives are urged to reduce the amount of salt and fat in the diet. One strategy is to follow the DASH diet, named from a study called Dietary Approaches to Stop Hypertension (DASH). The study found that the diet was particularly helpful in controlling the blood pressure of black Americans.
The ideal blood pressure goal among black Americans is uncertain. Based on the results of the African American Study of Kidney Disease and Hypertension (AASK) study, the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks issued the following guidelines in 2003:
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As with other racial groups, black Americans with uncomplicated high blood pressure should strive to reach a target of 140/80 mmHg.
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A target of 130/80 mmHg should be considered for black Americans with diabetes, kidney disease, a history of heart attack or stroke, or elevated risk for coronary artery disease.
Besides medication and dietary intervention, a number of additional approaches are often recommended to help lower pressure:
- Quitting smoking. This is perhaps the most important thing a smoker can do to promote his or her own health. Among many other side effects, smoking elevates blood pressure.
- Losing weight. Loss of weight in the abdominal area can immediately reduce blood pressure and helps to reduce the size of the heart. It is desirable to aim for people with a body mass index of less than 25. Weight loss accompanied by salt restriction may allow mild hypertensives to reduce or eliminate the need for medication.
- Eating a heart-healthy diet that is low in saturated fat. Cookbooks are available for people interested in cooking heart-healthy food. Dietitians are also available for personal counseling about diet.
- Getting adequate amounts of potassium, magnesium and calcium. Adequate intake of these minerals is thought by some experts to be more helpful than reducing salt intake for reducing blood pressure.
- Regular aerobic exercise. Exercising at least three to four times per week is helpful for regulating high blood pressure, keeping in mind that the regularity of the exercise is more important than the intensity of the workout. For example, studies have shown that Tai Chi (an ancient Chinese workout involving slow relaxing movements) may lower blood pressure almost as well as moderately intense aerobics.
- Limiting alcohol use to one 6-ounce glass of wine per day, one 12-ounce beer or one 1-ounce shot of distilled spirits for women, or 1 to 2 drinks per day for men.
- Limiting salt intake to 2,000 milligrams (2 grams) of sodium per day.
- Using stress management techniques. Emotional factors may play important roles in the development of hypertension. Studies have shown that cognitive-behavioral therapy, transcendental meditation, active religious faith and participation in church-related activities have all been associated with reducing blood pressure to healthy levels. (Watching or listening to religious services on radio or TV had no effect.)
- Having a pet may also lower blood pressure.
Women are also encouraged to discuss with a physician any increased risk of hypertension as a result of taking birth control pills, particularly if over the age of 35.
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