Difference in blood pressure response to ACE-Inhibitor monotherapy between black and white adults with arterial hypertension: a meta-analysis of 13 clinical trials

BMC Nephrology

Bernhard MW Schmidt⁵  Daniel W Fitzgerald²  Heiner Grosskurth³  Anthony C Liwa¹  Rita Beier⁴  Luke R Smart²  Robert N Peck² 

[1] Department of Clinical Pharmacology, Weill Bugando School of Medicine, Mwanza, Tanzania;Center for Global Health, Weill Cornell Medical College, New York, USA;Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;Department of Pediatrics, University Hospital Schleswig-Holstein, Lübeck Campus, Germany;Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany

关键词: Meta-analysis;    White;    Black;    Race;    ACE-inhibitors;    Treatment;    Hypertension;    Blood pressure;   

Others  :  1082838
DOI  :  10.1186/1471-2369-14-201

 received in 2013-05-04, accepted in 2013-09-24,  发布年份 2013

【 摘 要 】

Background

Among African-Americans adults, arterial hypertension is both more prevalent and associated with more complications than among white adults. Hypertension is also epidemic among black adults in sub-Saharan Africa. The treatment of hypertension among black adults may be complicated by lesser response to certain classes of anti-hypertensive agents.

Methods

We systematically searched literature for clinical trials of ACE-inhibitors among hypertensive adults comparing blood pressure response between whites and blacks. Meta-analysis was performed to determine the difference in systolic and diastolic blood pressure response. Further analysis including meta-regressions, funnel plots, and one-study-removed analyses were performed to investigate possible sources of heterogeneity or bias.

Results

In a meta-analysis of 13 trials providing 17 different patient groups for evaluation, black race was associated with a lesser reduction in systolic (mean difference: 4.6 mmHg (95% CI 3.5-5.7)) and diastolic (mean difference: 2.8 mmHg (95% CI 2.2-3.5)) blood pressure response to ACE-inhibitors, with little heterogeneity. Meta-regression revealed only ACE-inhibitor dosage as a significant source of heterogeneity. There was little evidence of publication bias.

Conclusions

Black race is consistently associated with a clinically significant lesser reduction in both systolic and diastolic blood pressure to ACE-inhibitor therapy in clinical trials in the USA and Europe. In black adults requiring monotherapy for uncomplicated hypertension, drugs other than ACE-inhibitors may be preferred, though the proven benefits of ACE-inhibitors in some sub-groups and the large overlap of response between blacks and whites must be remembered. These data are particularly important for interpretation of clinical drug trials for hypertensive black adults in sub-Saharan Africa and for the development of treatment recommendations in this population.

【 授权许可】

   
2013 Peck et al.; licensee BioMed Central Ltd.

【 图 表 】

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