ACE inhibitors in African American patients?

• A. They are equally effective without diuretic
• B. They may be less effective alone and often require a diuretic
• C. They are contraindicated in African American patients
• D. They cause immediate angioedema in all patients

Answer: (B)

In African American patients with hypertension, ACE inhibitors often don’t lower blood pressure as well when used alone because these patients frequently have lower plasma renin activity. Blocking the RAAS with an ACE inhibitor addresses angiotensin II–driven effects, but if volume and sodium retention are prominent, the BP reduction is limited. Adding a diuretic helps by reducing circulating volume and sodium content, which lowers BP and also can enhance the reflexes that drive renin release, making the ACE inhibitor more effective. That synergy explains why the best choice notes that ACE inhibitors may be less effective on their own and often require a diuretic.

This aligns with clinical patterns: in black patients, thiazide-type diuretics or calcium channel blockers are commonly effective first-line options, and ACE inhibitors are frequently used in combination with a diuretic to achieve better BP control. While ACE inhibitors can cause angioedema and have a higher risk of it in African American patients, they are not contraindicated for all, and the statement about them needing a diuretic to be effective remains the best answer.