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Racial and Sex Differences in the Response to First-Line Antihypertensive Therapy
John S Clemmer1, W Andrew Pruett1, Seth T Lirette2
1Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, Jackson, MS, United States.
Insights
Hypertension treatment in Black patients shows disparities. Combining renin-angiotensin system blockers with thiazides improves blood pressure control, suggesting race and gender-specific strategies for hypertension management.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Health Disparities
Background:
- Hypertension (HTN) disproportionately affects the Black population, with earlier onset, greater severity, and poorer blood pressure (BP) control compared to White individuals.
- Existing treatment strategies have minimally impacted these disparities, contributing to a 2-fold higher mortality rate in Black patients.
- The study setting, University of Mississippi Medical Center, is in the southeastern US Stroke Belt, an area with high rates of HTN and related diseases.
Purpose of the Study:
- To investigate initial blood pressure (BP) response to the first prescribed antihypertensive drug in Black and White patients.
- To identify racial and gender differences in BP control and response to specific antihypertensive drug classes.
- To inform tailored hypertension treatment strategies considering race and gender.
Main Methods:
- Retrospective analysis of over 30 million electronic health records from the UMC Research Data Warehouse.
- Inclusion of 5,973 White and 10,731 Black patients meeting study criteria.
- Statistical control for age, BMI, and drug dosage to assess BP response and HTN control (< 140/90 mmHg).
Main Results:
- Black males were less likely to achieve controlled BP and showed smaller BP reductions compared to White patients and Black females.
- Renin-angiotensin system (RAS) blockers alone did not significantly improve HTN control in Black patients.
- Combining RAS blockers with thiazide (THZ) diuretics showed significant benefit in Black patients compared to untreated or THZ-alone groups.
Conclusions:
- Single-pill formulations combining ARB or ACE inhibitors with thiazides are supported for initial hypertension therapy in Black patients.
- Hypertension treatment strategies should incorporate race and gender considerations for improved BP control efficiency.
- The study provides insights into real-world antihypertensive responses, crucial for addressing disparities in high-prevalence areas.
Abstract:
Objective: As compared to whites, the black population develops hypertension (HTN) at an earlier age, has a greater frequency and severity of HTN, and has poorer control of blood pressure (BP). Traditional practices and treatment efforts have had minor impact on these disparities, with over a 2-fold higher death rate currently for blacks as compared to whites. The University of Mississippi Medical Center (UMC) is located in the southeastern US and the Stroke Belt, which has higher rates of HTN and related diseases as compared to the rest of the country. Methods: We retrospectively analyzed the UMC's Research Data Warehouse, containing >30 million electronic health records from >900,000 patients to determine the initial BP response following the first prescribed antihypertensive drug. Results: There were 5,973 white (45% overall HTN prevalence) and 10,731 black (57% overall HTN prevalence) patients who met criteria for the study. After controlling for age, BMI, and drug dosage, black males were overall less likely to have controlled BP (defined as < 140/90 mmHg) and were associated with smaller falls in BP as compared to whites and black females. Blockers of the renin-angiotensin system (RAS) failed to significantly improve odds of HTN control vs. the untreated group in black patients. However, our data suggests that these drugs do provide significant benefit in blacks when combined with THZ, as compared to untreated and as compared to THZ alone. Conclusion: These data support the use of a single-pill formulation with ARB or ACE inhibitor with a thiazide in blacks for initial first-line HTN therapy and suggests that HTN treatment strategies should consider both race and gender. Our study gives a unique insight into initial antihypertensive responses in actual clinical practice and could have an impact in BP control efficiency in a state with prevalent socioeconomic and racial disparities.
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