The 2010 international society of hypertension in blacks consensus statement-is there a role for opinion in guidelines or consensus reports? A review

Abstract

Hypertension is a major cause of disproportionate cardiovascular disease morbidity and mortality in African Americans. Increasingly, medical management is required to be based on the best peer-reviewed evidence versus individual preferences. The 2010 International Society of Hypertension in Blacks (ISHIB) Consensus Statement contained controversial recommendations: lower target blood pressure levels for primary and secondary prevention; chlorthalidone as preferred thiazide-like diuretic; combination therapy with blood pressure >15/10 mmHg above goal; and the preferential use of long-acting calcium channel blocker/renin-angiotensin system blocker regimen when needed. However, accompanying editorial and other critics have suggested the ISHIB document was less than evidence-based and flawed in several of its salient positions. Steadfast utilization of scientific data alone to form recommendations may decrease the potential to help clinicians and patients make appropriate decisions. The ISHIB report methodology was transparent in its broad-based approach, using relevant studies, with and without adequate black cohorts, and non-randomized epidemiologic data. There is a definite place for expert opinions in managing black patients with hypertension to curtail the unacceptable, disproportionately high levels of associated death and disability. Judgment will be required to synthesize optimal treatment of blacks with hypertension. © Touch Briefings 2011.