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Ethnic differences in blood pressure response to first and second-line antihypertensive therapies in patients

Ajay K Gupta1, Neil R Poulter, Joanna Dobson

  • 1ICCH, Imperial College London, London, UK. A.K.Gupta@imperial.ac.uk

American Journal of Hypertension
|August 21, 2010
PubMed

Insights

Blood pressure drug responses vary significantly by ethnicity. This study highlights ethnic differences in blood pressure (BP) lowering effects for both initial and second-line antihypertensive therapies.

Area of Science:

  • Cardiology
  • Pharmacology
  • Genetics

Background:

  • Antihypertensive drug efficacy may vary across ethnic groups.
  • Limited data exists on ethnic differences in response to second-line antihypertensive therapy.

Purpose of the Study:

  • To investigate ethnic variations in blood pressure (BP) response to first- and second-line antihypertensive treatments.
  • To compare BP-lowering effects of atenolol, amlodipine, thiazide diuretics, and perindopril across European, African, and South-Asian populations.

Main Methods:

  • Analysis of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA) BP-lowering arm.
  • Comparison of BP levels in European (n=4,368), African (n=203), and South-Asian (n=132) patients.
  • Regression models assessed interactions between ethnicity and BP response to monotherapy and add-on therapies, adjusting for confounders.

Main Results:

  • Significant ethnic differences in BP response to atenolol monotherapy were observed (P=0.05), with black patients showing less response compared to white patients.
  • BP response to amlodipine monotherapy did not significantly differ by ethnicity.
  • Ethnic variations in BP response to second-line therapy were significant (P=0.004). Addition of a diuretic to atenolol showed similar BP lowering across groups, but adding perindopril to amlodipine yielded differential responses: South-Asians had greater BP reduction, while black patients had lesser reduction compared to whites.

Conclusions:

  • Substantial ethnic disparities exist in blood pressure responses to both first- and second-line antihypertensive medications.
  • These findings underscore the need for personalized antihypertensive treatment strategies considering patient ethnicity.
Abstract

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