The two principal forms of non-drug treatment, weight reduction and salt restriction, are at least as important in blacks as in whites. Blacks tend to be a little more salt sensitive than whites. Exercise has also been shown to be very effective in reducing blood pressure in blacks.
There are some minor differences in the responses to antihypertensive drug treatment. The two most widely used classes of agents are beta blockers and diuretics, and blacks tend to show a slightly better response to the latter, while whites do better with the former. The other class of drug where there also seems to be a racial difference is the angiotensin converting enzyme inhibitors (ACE inhibitors), where again whites tend to show a slightly bigger response than blacks.
These differences can all be attributed to the fact that low renin hypertension is commoner in blacks, and high renin hypertension in whites. Beta blockers and ACE inhibitors work by blocking the effects of renin on blood pressure, so they are most effective when the level of renin is high. Conversely, diuretics work best when there is salt retention and renin is low.
It should be emphasized that these are only trends, however. There are many blacks who do well with both beta blockers and ACE inhibitors, and ethnicity is not a good guide as to who will respond well to a particular drug and who will not.
