Race-based Therapy for Hypertension: Possible Benefits and Potential Pitfalls

Keith C. Ferdinand; Daphne P. Ferdinand

Expert Rev Cardiovasc Ther. 2008;10(6):1357-1366.

Antihypertension Therapy Response in Black Patients

Monotherapy for BP-lowering in Blacks may be more effective with thiazide diuretics and long-acting CCBs than β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs).^[10] For all patient groups, including Blacks, thiazide diuretics are effective as initial therapy and are well-tolerated medications. As first-line therapy in Blacks, diuretics reduce BP, stroke, HF and overall CVD.^[36] Moreover, when additional agents are needed, the thiazide diuretics increase the efficacy of agents such as β-blockers, ACEIs and ARBs. Long-acting CCBs, of both dihydropyridine and nondihydropyridine types, reduce BP, stroke and cardiovascular events effectively in Blacks. At least two large trials, The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), with amlodipine, and the International Verapamil-Trandolapril Study (INVEST), with verapamil SR, have demonstrated cardiovascular benefits in Blacks using long-acting CCB-based therapies.^[36,37] While in ALLHAT, lisinopril, starting at 20 mg with a goal of 40 mg, lowered BP (with increased stroke) less effectively than chlorthalidone in INVEST, a long-acting CCB added to larger doses of the ACEI (trandolapril) demonstrated similar BP-lowering and outcomes in Blacks as compared with Whites.

Nevertheless, race is not a powerful predictor of drug response in any individual, and race alone should not be the basis for clinical decisions regarding the class of antihypertensive drug utilized. A meta-analysis of 15 clinical trials demonstrated that a vast majority of Whites and Blacks respond similarly to commonly used antihypertensive drugs.^[38] Furthermore, there appeared to be wide variation in drug-associated changes in BP within each race. Manual and computerized searches of MEDLINE (1983 to March 2003) with a total of 9307 White subjects and 2902 Black subjects noted drug-associated changes in diastolic BP. The mean difference between Whites and Blacks ranged from 0.6 to 3.0 mmHg, with a standard deviation within each race of 5.0-10.1 mmHg. The percentage of Whites and Blacks with similar changes in systolic BP ranged from 83 to 93%. The authors concluded that choices of specific medications should not be based on race alone.

1 2 3 4 5 6 7 8 9 10 11 12 13

Next Section

/publishers/exprev/erc/description/cover-erc.jpg

No writing assistance was utilized in the production of this manuscript.

Cite this: Race-based Therapy for Hypertension: Possible Benefits and Potential Pitfalls - Medscape - Nov 01, 2008.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.