What Are the Best Treatment Options for High Blood Pressure (Hypertension) in Black Adults?

Nearly half of all adults in the U.S. have high blood pressure. If left untreated, the consequences are the same for everyone. But there are some differences you should be aware of. One of these differences is that high blood pressure is much more common in Black people as compared to other groups in the U.S. It affects almost 60% of Black adults in the U.S., as compared to almost 50% of white and Asian adults and about 40% of Hispanic adults.

Hypertension also seems to be more severe in Black adults than in other groups. Because of this, there used to be a belief that some medications don’t work as well in Black people with high blood pressure as they do in other groups. These differences led to Black people receiving different treatments in the past. 

This has since changed. Treatment options are no longer race-based, and they’re available to anyone based on your medical history. 

Why is high blood pressure more common and more severe in Black people?

There’s no definitive answer for why high blood pressure is more common and more severe in Black people. Rather than because of a race-based difference, it’s more likely due to social and environmental risk factors. 

How is high blood pressure treated?

There are treatment plans that don’t require medication and some that do. The approach to treating high blood pressure depends on how severe it is. A healthy lifestyle can help keep hypertension in check. In fact, it’s recommended you make lifestyle modifications to help lower your blood pressure — even if a healthcare professional prescribes medication for you. 

Non-medication treatments for high blood pressure

First, let’s define what high blood pressure is on a test reading:

• Elevated blood pressure: systolic 120 mmHg to 129 mmHg, and diastolic under 80 mmHg) 

• Stage 1 hypertension: systolic 130 mmHg to 139 mmHg, or diastolic 80 mmHg to 89 mmHg), 

In these cases, non-medication management is recommended. This would include diet, exercise, and lifestyle changes. 

Some examples of these changes include the following:

• Eat a nutritious diet full of fruits and vegetables. The DASH diet has been shown to help lower blood pressure.

• Limit salt and saturated fat intake. This also helps protect against heart disease and stroke.

• Keep yourself at a comfortable weight. You and your healthcare team should come up with this goal together.

• Get some exercise. It’s recommended that you get at least 30 minutes of moderate-intensity exercise — such as brisk walking or bicycling — 5 times a week.

• Make plans to quit smoking. This will help lower both your blood pressure and your risk of a heart attack.

• Limit alcohol. There’s no safe amount of alcohol to drink. Try to limit alcohol to no more than 2 drinks per day for men and 1 drink per day for women.

• Get a good night’s sleep. This means at least 7 to 9 hours of sleep a night.

Before making any changes to your diet and exercise, it’s important to discuss them with a healthcare professional. Our bodies are unique, and what works for one person may not be the right fit for you.

Medication treatment options for high blood pressure

Your healthcare team will recommend treatment with medication in the cases: 

• Your blood pressure doesn’t improve with changes to your lifestyle habits.

• Your blood pressure is stage 2 (systolic at least 140 mmHg or diastolic at least 90 mmHg).

There are many types of medications that are used to treat high blood pressure. These medications work alone or in combination with one another. Which one is best for you depends on your medical history, which other medications you may be taking, and often some trial and error. 

These are some of the most common types of blood pressure medications that are used:

• Diuretics: Also known as “water pills,” diuretics lower blood pressure by increasing urination to get rid of extra fluid. This makes it easier for your heart to pump. Commonly used diuretics include hydrochlorothiazide (HCTZ) and chlorthalidone.

• Calcium channel blockers: These work by blocking calcium from entering heart cells. This allows your heart to slow down and not work as hard, thereby lowering your blood pressure. Commonly used calcium channel blockers include amlodipine (Norvasc) and nifedipine (Procardia, Procardia XL).

• Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors block the production of a protein known as angiotensin I, allowing your blood vessels to relax and blood pressure to decrease. Commonly used ACE inhibitors include lisinopril and benazepril (Lotensin).

• Angiotensin receptor blockers (ARBs): These work by relaxing blood vessels and blocking the action of another protein known as angiotensin II. Commonly used ARBs include losartan (Cozaar) and valsartan (Diovan).

• Beta blockers: These decrease blood pressure by decreasing the heart rate. This allows your heart to beat more slowly and with less force. Commonly used beta blockers include metoprolol (Lopressor) and labetalol (especially in pregnancy).

• Alpha blockers: These medications lower blood pressure by relaxing the blood vessels, making it easier for your heart to pump. A commonly used beta blocker includes prazosin (Minipress).

• Vasodilators: This class allows blood pressure to decrease by relaxing blood vessels. A commonly used vasodilator includes hydralazine.

What is the best blood pressure medication for African Americans?

There’s no specific medication that’s best for high blood pressure in African Americans. In general, there are a few types of medications that are considered first-choice treatments for most people with high blood pressure, including Black adults. These include: 

• Thiazide diuretics (a type of “water pill”)

• ACE inhibitors

• ARBs

• Calcium channel blockers

For the most part, these medications are equally effective in lowering blood pressure. They also have a low risk of side effects for most who take them. 

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Written by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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