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Systematic review: antihypertensive drug therapy in black patients
Lizzy M Brewster1, Gert A van Montfrans, Jos Kleijnen
1Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Insights
Antihypertensive drugs vary in effectiveness for lowering blood pressure in black adults. However, once blood pressure goals are met, evidence does not strongly support differences in reducing morbidity and mortality outcomes among these drugs.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Hypertension is more prevalent and severe in Black individuals compared to White individuals.
- This disparity leads to increased rates of illness and death in the Black population.
Purpose of the Study:
- To systematically review the effectiveness of various antihypertensive medications.
- The review focuses on reducing blood pressure, morbidity, and mortality in hypertensive Black adults.
Main Methods:
- A comprehensive search of multiple databases (MEDLINE, EMBASE, LILACS, African Index Medicus, Cochrane Library, PubMed) was conducted.
- Included were randomized controlled trials comparing drug efficacy against placebo for blood pressure outcomes, and against placebo or other drugs for morbidity and mortality outcomes.
- Data were independently extracted by two reviewers.
Main Results:
- Beta-blockers and angiotensin-converting enzyme inhibitors showed no significant difference from placebo in reducing systolic and diastolic blood pressure, respectively.
- Calcium-channel blockers, diuretics, central sympatholytics, alpha-blockers, and angiotensin II receptor blockers were more effective than placebo for blood pressure reduction.
- Calcium-channel blockers were effective across all subgroups, including those with severe hypertension (baseline diastolic blood pressure ≥ 110 mm Hg).
- No significant differences in major morbidity and mortality outcomes were observed when drugs were combined to achieve blood pressure goals.
- Diuretics were associated with an increased occurrence of diabetes, and angiotensin-converting enzyme inhibitors with a higher risk of cardiovascular events.
Conclusions:
- Antihypertensive medications demonstrate varying efficacy in lowering blood pressure among Black patients.
- Currently, there is insufficient robust evidence to suggest differences in the efficacy of these drugs for reducing morbidity and mortality once blood pressure targets are achieved.
Background:
Hypertension occurs more frequently and is generally more severe in black persons than in white persons, leading to excess morbidity and mortality.
Purpose:
To systematically review the efficacy of different antihypertensive drugs in reducing blood pressure, morbidity, and mortality in hypertensive black adults.
Data Sources:
The following databases were searched from their inception through November 2003: MEDLINE, EMBASE, LILACS (Literatura Latino-Americana y del Caribe en Ciencias de la Salud), African Index Medicus, and the Cochrane Library. PubMed was also searched from September 2003 through March 2004. Searches were conducted without language restriction.
Study Selection:
Randomized, controlled trials of drugs versus placebo (blood pressure outcomes) or drugs versus placebo or other drugs (morbidity and mortality outcomes).
Data Extraction:
2 reviewers independently extracted data.
Data Synthesis:
The efficacy of beta-blockers in reducing systolic blood pressure and the efficacy of angiotensin-converting enzyme inhibitors in achieving diastolic blood pressure goals did not significantly differ from that of placebo (weighted mean difference for beta-blockers, -3.53 mm Hg [95% CI, -7.51 to 0.45 mm Hg]; relative risk for angiotensin-converting enzyme inhibitors, 1.35 [CI, 0.81 to 2.26]). In the pooled analyses, other reviewed drugs (calcium-channel blockers, diuretics, central sympatholytics, alpha-blockers, and angiotensin II receptor blockers) were more effective than placebo in reducing blood pressure, but only calcium-channel blockers remained effective in all prespecified subgroups, including patients with a baseline diastolic blood pressure of 110 mm Hg or greater. Main morbidity and mortality outcomes did not differ significantly between treatment groups when drugs were combined to reach blood pressure goals. However, trial results indicated a greater occurrence of diabetes with diuretics and a higher risk for cardiovascular events with drug regimens that included angiotensin-converting enzyme inhibitors.
Limitations:
This meta-analysis evaluated the blood pressure lowering-efficacy of monotherapy only.
Conclusions:
Drugs differ in their efficacy for reducing blood pressure in black patients, but there is no solid evidence that efficacy for reducing morbidity and mortality outcomes differs once patients achieve the blood pressure goal.
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