Are Angiotensin-Converting Enzyme Inhibitors Effective in the Treatment of Hypertension in Black Patients?

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Hypertension is a global health crisis with low control rates due to access, cost, and inertia.
• Angiotensin-converting enzyme inhibitors (ACEis) are key antihypertensives, but historical data suggested reduced efficacy in Black patients.
• Current guidelines often restrict initial ACEi use for hypertension in Black individuals.

Purpose of the Study:

• To review the evidence supporting the guideline recommendation against initial ACEi use in Black patients.
• To assess the consistency and quality of evidence regarding ACEi efficacy across different populations.
• To evaluate the basis for race-based recommendations in antihypertensive therapy.

Main Methods:

• Systematic review of clinical trials and guideline recommendations concerning ACEi use in hypertension.
• Analysis of evidence regarding blood pressure response to ACEis in diverse patient groups.
• Examination of how 'race' was defined and utilized in the reviewed studies.

Main Results:

• High-quality evidence to support avoiding ACEis as initial therapy in Black patients was limited.
• ACEis have demonstrated effectiveness in blood pressure reduction across all populations, especially in combination therapy.
• The identification and definition of race in studies were often inconsistent or not described.

Conclusions:

• The recommendation to avoid ACEis as initial therapy for hypertension in Black patients is not strongly supported by high-quality evidence.
• Antihypertensive therapy decisions should prioritize individual patient factors over the social construct of race.
• Further research is needed to clarify the role of ACEis and other antihypertensives in diverse populations, moving beyond race-based guidelines.