Studies of hypertensive pathophysiology in black patients indicate that low renin levels, salt sensitivity, and impaired salt excretion are more prevalent. Obesity is more prevalent in black women as compared to other black or white adults, and dietary intake of potassium is often lower in blacks as compared to whites. These facts suggest that lifestyle modifications might be the most effective strategy to lower blood pressure in this population. Reductions in body weight of as little as 7 lb and use of oral potassium supplements can significantly reduce blood pressure.

Within the African American group, the responsiveness to monotherapy with ACE inhibitors, angiotensin receptor blockers, and beta blockers may be less than the responsiveness to diuretics and calcium channel blockers, but these differences are corrected when diuretics are added to the neurohormonal antagonists [Crit Pathw Cardiol. 2007 Jun;6(2):67-71].

In addition to lifestyle modification, the agent(s) of choice in black hypertensives are the diuretics and calcium channel blockers. However, as you may know that each antihypertensive agent drops blood pressure ~ 10 mmHg and these individuals with significantly elevated blood pressure often require combination therapy and may be on 3-4 agents to reach to target blood pressure.

Thanks dear Dr Parmar for rising these points.

In fact my concern was much to point out the fact that African patients might not be identical to African American in terms of genetical and environmental risk factors.

Salt sensitivity and renal sodium handling were studies in very few groups and such data need more external validation. So, with the rising epidemic of HBP we face in Africa I do think we should better explore underlying determinants in order to propose a adequate management strategies.