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Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks
Sripal Bangalore1, Gbenga Ogedegbe2, Joyce Gyamfi3
1The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York.
Insights
In hypertensive Black patients, angiotensin-converting enzyme inhibitors showed increased cardiovascular risks compared to calcium channel blockers or thiazide diuretics. Beta-blockers showed no significant difference in outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Hypertension management is crucial, with angiotensin-converting enzyme inhibitors (ACEIs) widely prescribed.
- The comparative effectiveness of ACEIs versus other antihypertensive agents in Black patients with hypertension remains under-established.
- This study addresses the efficacy gap for ACEIs in a specific demographic.
Purpose of the Study:
- To evaluate the comparative effectiveness of ACEIs against calcium channel blockers (CCBs), thiazide diuretics (TDs), and beta-blockers (BBs) in hypertensive Black patients.
- To assess the risk of major adverse cardiovascular events (MACE) associated with different antihypertensive drug classes.
- To provide real-world evidence for optimizing hypertension treatment in this population.
Main Methods:
- A retrospective cohort study utilizing data from 434,646 patients.
- Propensity score matching was employed to create comparable groups for ACEIs vs. CCBs and ACEIs vs. TDs.
- Primary outcome: composite of death, myocardial infarction, and stroke. Secondary outcomes included individual components and heart failure.
Main Results:
- ACEIs were associated with a significantly higher risk of MACE compared to CCBs (HR, 1.45; P = .0003) and TDs (HR, 1.65; P < .0001).
- Specific risks for myocardial infarction, stroke, and heart failure were elevated with ACEIs versus CCBs and TDs.
- No significant differences in outcomes were observed between ACEIs and BBs.
Conclusions:
- In hypertensive Black patients, ACEIs are linked to increased cardiovascular event risk when contrasted with CCBs or TDs.
- These findings suggest a need for careful consideration of ACEI use in this patient group.
- Alternative antihypertensive agents may offer better safety profiles for Black patients with hypertension.
Background:
Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established.
Methods:
We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure.
Results:
In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P = .0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P = .02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P = .001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P = .0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P < .0001), death (HR, 1.35; 95% CI, 1.03-1.76; P = .03), myocardial infarction (HR, 4.00; 95% CI, 1.34-11.96; P = .01), stroke (HR, 1.97; 95% CI, 1.34-2.92; P = .001), and heart failure (HR, 3.00; 95% CI, 1.99-4.54; P < .0001). For the angiotensin-converting enzyme inhibitors vs β-blocker comparison, the outcomes between the groups were not significantly different.
Conclusions:
In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics.
Related Concept Videos
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
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01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:28Hypertension IV: Drug Therapy and Lifestyle Modifications
01:28Antihypertensive Drugs: Types of β-Blockers