I remember coming across conflicting evidences about the differences in therapeutic outcomes from ACE/ARBs between whites and black

http://www.ncbi.nlm.nih.gov/pubmed/24842464 .

Other studies have also shown a difference in renal Na handling between blacks and whites (unrelated to age and dietary habits). Renal tubular epithelial Na channels could be expressed in different variants, and studies have shown some variants have enhanced Na shuttling potential. "(are these over active ENaC more expressed in blacks-???" . If that is the case, ACEs/ARBs may have comparatively lower influence on Na retention.... as the activity of Aldosterone in retaining Na remains poorly challenged by the drugs.  Differences in other facets of the RAA-Kalikren pathway have also been shown contribute 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176798/ 

@Jemal M Yesuf : Thank you for your reply and the link.

There are literature showing African origin population have over activated RAAS. On the other hand, several papers have explained that  ACEIs are less effective for such population because of low rennin release. if there is low rennin what activated RAAS? could there be a feedback mechanism?

 Low rennin (in turn less ACE) may increase bradikynin level. This could explain for less tolerability of ACEIs among black population.   

Low renin production normally means less activation of RAAS. The reports that i saw argue that there are several mechanisms by which blacks appear to be more salt-sensitive and more susceptible for HTN and its complications.... these are more genetic alterations (variants)... like the overactive ENaCs mentioned above, even at low levels of renin, as long as there is excessive Na retention, ACEIs may seem to have lesser impact on reducing BP and plasma Na level.... but still ACEIs , i believe work effectively in preventing HTN related damages to blood vessels and the heart... and their use can still be warranted..... 

In blacks, RAAS is relatively down-regulated because of high intake of salt by this community.As a result, ACEIs are not that effective becuse ACEIs work best when RAAS is unregulated.

Dear Bhupinder 

Thank you for your answer. Though I have some concerns. Salt sensitivity may not related with intake as high salt intake does  not describe all black population. Rather extreme sensitivity may be due to genetic trait. Little is known abut heritability of this characteristics (salt sensitivity). http://hyper.ahajournals.org/content/28/5/854.full 

Management of hypertension in ethnic minorities

Jawad M Khan and D Gareth Beevers

Hypertension, currently defined as a blood pressure > 140 mm Hg (systolic) and/or > 90 mm Hg (diastolic), is a common problem. In a western adult population the prevalence of hypertension exceeds 20%.1 The prevalence of hypertension increases with age and is higher in ethnic minority groups in the UK. In the Health Survey for England (2001) the prevalence of hypertension was 3.3% in those aged < 40 years, 27.9% in those aged between 40–79 years, and 49.9% in those aged 80 years and older.2

The two main ethnic origin groups within the UK are the Afro-Caribbean and South Asians. The majority of studies have reported a higher prevalence and significantly higher mean blood pressure levels among both Afro-Caribbean populations and South Asians compared to their white counterparts.3 In a south London community based study, compared with whites, age and sex standardised prevalence ratios for hypertension were 2.6 in people of African descent and 1.8 in those of South Asian origin.4 However, average blood pressure varies between different subgroups of South Asians, being highest in Sikhs, similar to whites in Muslims, and intermediate in Hindus.5 In addition, Indians have higher blood pressures, Pakistanis lower blood pressures, with Bangladeshis having even lower blood pressures than the native white population

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769018/

Together with this I want to raise a question.Most of the studies done on ACEIs are done in USA.can we extrapolate this research for those peoples living in africa (Ethiopia)?.Because the JNC 8 guideline recommends only CCBs and thiazides type diuretics as first line pharmacotherapy for african american hypertensive patients.

@Getandale Zeleke 

Yes, The Ethiopian Standard Treatment Guideline also consider this fact. First line drug of choice are diuretics. JNC 8 guideline did not say only Diuretics and /or CCBs. Regardless of race ACEIs are still preferable for hypertensive patients with CKD.

 Recommendation 8

''In the population aged 18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B)''

file://zkh/dfs/Gebruikers24/BerheDF/desktop/jsc130010%20(1).pdf