What Are the Best Treatment Options for High Blood Pressure 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 how common it is in African American adults. Non-Hispanic Black adults in the U.S. have significantly higher rates of high blood pressure compared to other races. 

There are also differences in the treatments. Some medicines don’t work as well in Black people with high blood pressure as they do in other groups. These differences help your provider choose the best treatment plan for you. 

How common is high blood pressure in Black adults?

High blood pressure is much more common in Black people as compared to other groups in the U.S. It affects 56% of Black adults in the U.S. as compared to 48% of white adults, 46% of Asian adults, and 39% of Hispanic adults.

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High blood pressure in Black adults is also more severe. As a result, it can be harder to control with medications. 

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. Some theories have looked at genetic and environmental factors as possible causes, but it isn’t very well understood.

Is there a genetic reason Black adults have higher blood pressure?

One genetic factor may be that some Black adults might hold onto more salt in the body than others. When you have more salt in your bloodstream, your body also holds on to extra fluid. More fluid can cause increased pressure in your blood vessels. This leads to a higher blood pressure reading.

Research in Black communities outside of the U.S. suggests that there may be other factors. In the U.S., high blood pressure is more common in Black adults. But in other Black communities around the world, Black and white adults have similar rates of high blood pressure. So there may not be a genetic reason to explain why high blood pressure is more common in Black people.

Is there an environmental reason Black adults have higher blood pressure?

Another theory is that there are environmental factors at play. Your environment and the conditions you live in have an impact on your health. Black people in the U.S. have higher poverty rates. And lack of access to community resources for healthy living may increase the risk for high blood pressure. This includes:

• Lack of access to healthy foods

• Lack of access to healthcare

• Decreased funding for physical education programs in schools

• Fewer parks, playgrounds, and community exercise spaces

Evidence shows that living in the U.S. increases your risk for developing high blood pressure. Immigrants now in the U.S. have a much greater risk for high blood pressure the longer they live in the U.S. environment.

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 your provider prescribes medication for you. 

Non-medication treatments for high blood pressure

For elevated blood pressure (systolic 120 to 129 mmHg and diastolic under 80 mmHg) or stage 1 hypertension (systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg), non-medication management is recommended. This would include diet, exercise, and lifestyle changes. 

Some examples of these changes include the following:

• Eat a healthy diet full of fruits and vegetables.

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

• Keep yourself at a healthy weight. You and your provider should come up with this goal together.

• Get some exercise. The Physical Activity Guidelines for Americans from the U.S. Department of Health and Human Services recommends at least 2 hours and 30 minutes of moderate-intensity exercise — such as brisk walking or bicycling — every week for the average adult.

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

• Limit alcohol to no more than 2 alcoholic drinks per day for men and 1 alcoholic drink per day for women.

• Get at least 7 hours of sleep at night.

Before making any changes to your diet and exercise, it’s important to discuss them with your provider. 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

When high blood pressure persists or has advanced to stage 2 (systolic at least 140 mmHg or diastolic at least 90 mmHg), medication is recommended as additional treatment.

There are many types of medications that are used to treat high blood pressure. These medications are sometimes used alone, or in combination with one another. Your healthcare provider will decide which medications may be best for you based on your medical history, other medications you may be taking, and how well your blood pressure responds to treatment. These are some of the most common types of medications that are used:

• Diuretics: Also known as “water pills,” they lower blood pressure by increasing urination to get rid of extra fluid. This makes it easier for your heart to pump.

• 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.

• 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.

• Angiotensin receptor blockers (ARBs): These work by relaxing blood vessels and blocking the action of another protein known as “angiotensin II.” 

• Beta blockers: These decrease blood pressure by decreasing the heart rate. This allows your heart to beat more slowly and with less force.

• Alpha blockers: These medications lower blood pressure by relaxing the blood vessels, making it easier for your heart to pump.

• Vasodilators: This class allows blood pressure to decrease by relaxing blood vessels.

Is high blood pressure treated differently in Black adults?

In general, there are a few types of medications that are considered first-choices treatments for high blood pressure. These include thiazide diuretics (a type of “water pill”), ACE inhibitors, ARBs, and 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. But in Black adults, ACE inhibitors and ARBs are not always the best first-choice treatment option.

Why are ACE inhibitors and ARBs sometimes not recommended for Black adults?

The simple answer is that these medications tend to not work as well in Black people. The reason for this boils down to the way ACE inhibitors and ARBs work. 

ACE inhibitors and ARBs both work by interfering with the hormonal circuit in the body that increases blood pressure — the renin-angiotensin-aldosterone system. They work best when the cause of high blood pressure is a high level of renin. But Black adults with high blood pressure often have lower levels of renin. 

Besides being less effective in Black adults, there is another concern. Very rarely, ACE inhibitors can cause angioedema. This is a potentially life-threatening reaction where the lips, tongue, and throat swell and make it difficult to breathe. Angioedema is a medical emergency. Angioedema from ACE inhibitors is more common in Black people than any other race or ethnicity.

ARBs are less likely to cause angioedema than ACE inhibitors. But many providers will choose to avoid both of these medications just to be on the safe side.

What are the hypertension treatment options for African Americans?

Experts recommend Black adults start with either a thiazide diuretic — such as chlorthalidone or hydrochlorothiazide — or a calcium channel blocker like amlodipine (Norvasc). If blood pressure readings are still too high after taking one of these medications for a while, providers will likely recommend a combination of medications.

An ACE inhibitor or an ARB is not typically used to treat hypertension by itself for Black adults, but either can be added as a second medication. Your provider may also recommend ACE inhibitors and ARBs when you have other health conditions that affect the heart, like diabetes or heart failure. If you’re not sure why you are taking one of these two blood pressure medications, you should discuss it with your provider at your next checkup.

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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.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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