Ethnic variations in the pharmacological and nonpharmacological treatment of hypertension: Biopsychosocial perspective

Kimberly A. Brownley, Barry Hurwitz, Neil Schneiderman

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Blood pressure regulation is a complex, dynamic process influenced by psychosocial, behavioral, and cultural factors. Integrative theories of cross-population differences in the prevalence of hypertension and response to treatment include physiological, social, and genetic perspectives. Ethnic differences in salt sensitivity, calcium regulation of sodium flux, vascular reactivity to psychosocial stress, and drug metabolism are integral components of observed cross-cultural variations in hypertension. In general, pharmacological treatment of hypertension in blacks is most consistently achieved through diuretics and calcium-channel blockers; angiotensin-converting enzyme inhibitors and beta-blockers are more efficacious in whites. These stereotypical patterns are consistent with the higher prevalence of salt sensitivity, stress-induced vasoconstriction and slower natriuresis, and α-adrenergic receptor mediated vascular reactivity observed in blacks compared with whites. Some antihypertensive agents produce adverse glucose metabolic side effects, thus contraindicating their use in individuals with high sympathetic tone, insulin resistance, or obesity. Cross-population differences in adopted guidelines for treating hypertension exist but are not likely a factor in observed ethnic differences in rate of treatment or control. Attitudes toward nontraditional treatment options (e.g., herbal medicine), political and individual responsibilities in health care, and adaptations to acculturation and urbanization stress differ between and within societies and thus play a role in observed cross-cultural differences in hypertension as well. The value of regular exercise in controlling hypertension is widely recognized, and reductions in blood pressure reactivity to behavioral stress following acute exercise have been documented; however, empirical studies of ethnic differences in exercise-related blood pressure control are lacking. Overall, increased awareness of the multifactorial nature of hypertension by both the physician and the patient will facilitate treatment of this disease on an individual basis.

Original languageEnglish
Pages (from-to)607-639
Number of pages33
JournalHuman Biology
Volume71
Issue number4
StatePublished - Aug 1 1999

Fingerprint

hypertension
Pharmacology
Hypertension
ethnic differences
blood pressure
exercise
blood
Exercise
Blood Pressure
blood vessels
Therapeutics
Blood Vessels
Salts
calcium
acculturation
beta-adrenergic antagonists
salt
salts
cultural differences
calcium channel blockers

Keywords

  • Ethnicity
  • Exercise
  • Herbal medicine
  • Hyperinsulinemia
  • Hypertension
  • Pharmacology

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Genetics
  • Genetics(clinical)
  • Ecology, Evolution, Behavior and Systematics

Cite this

Ethnic variations in the pharmacological and nonpharmacological treatment of hypertension : Biopsychosocial perspective. / Brownley, Kimberly A.; Hurwitz, Barry; Schneiderman, Neil.

In: Human Biology, Vol. 71, No. 4, 01.08.1999, p. 607-639.

Research output: Contribution to journalArticle

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