Antihypertensive efficacy and safety of losartan alone and in combination with hydrochlorothiazide in adult African Americans with mild to moderate hypertension

Flack, John M.; Saunders, Elijah; Gradman, Alan H.; Kraus, William E.; Lester, F. Martin; Pratt, J. Howard; Alderman, Michael H.; Green, Stephen; Vargas, Ramón; Espenshade, Melanie; Ceesay, Paulette; Alexander, Joe; Goldberg, Allan I.

doi:10.1016/s0149-2918(01)80101-6

Cited by 59 publications

(34 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9 Previous studies of adults with HTN have shown black subjects to be less responsive to monotherapy and thus often requiring treatment with drugs from 2 or more antihypertensive drug classes. 10 Additional study of physician decision making, as well as clinical outcomes, is warranted to better understand the racial patterns observed in this study.…”

Section: Discussionmentioning

confidence: 99%

Antihypertensive Prescribing Patterns for Adolescents With Primary Hypertension

Yoon¹,

Cohn²,

Rocchini³

et al. 2012

Pediatrics

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Primary hypertension is a growing concern in adolescents due to its association with the obesity epidemic. Recent studies have examined underdetection and underdiagnosis of hypertension in adolescents but medical management of primary hypertension in adolescents is not welldescribed.WHAT THIS STUDY ADDS: Our study describes patterns of antihypertensive prescribing for adolescents with primary hypertension including the use of monotherapy versus combination therapy by physicians of different specialties and factors associated with receipt of antihypertensive therapy over a multi-year period. abstract BACKGROUND: Hypertension is an increasingly common problem in adolescents yet current medical management of primary hypertension in adolescents has not been well-described. METHODS:We identified adolescents with primary hypertension by International Classification of Diseases, Ninth Revision codes and looked at prescription patterns chronologically for antihypertensive drug class prescribed and the specialty of prescribing physician. We also examined patient demographics and presence of obesity-related comorbidities. During 2003During -2008, there were 4296 adolescents with primary hypertension (HTN); 66% were boys; 73% were aged 11 to 14 years; 53% were black, 41% white, and 4% Hispanic; and 48% had obesity-related comorbidity. Twenty-three percent (977) received antihypertensive prescription. White subjects (odds ratio [OR]: 1.61; confidence interval [CI]: 1.39-1.88), older adolescents ($15 years, OR: 2.11; CI: 1.79-2.48), and those with comorbidity (OR: 1.57; CI: 1.36-1.82) were more likely to receive antihypertensive prescriptions controlling for gender and years of Medicaid eligibility in logistic regression. Angiotensin converting enzyme inhibitors were the most frequently prescribed monotherapy. Nearly two-thirds of adolescents received prescriptions from adult primary care physicians (PCPs) only. More than one-quarter of adolescents who received a prescription received combination therapy, which was most often prescribed by adult PCPs. RESULTS:CONCLUSIONS: Adult PCPs were the leading prescribers of antihypertensives for adolescents with primary HTN. Race differences exist in physicians' prescribing of antihypertensives to adolescents with primary HTN. The choice of antihypertensives by physicians of different specialties warrants additional study to understand the underlying rationale for treatment decisions and to determine treatment effectiveness. Pediatrics 2012;129:e1-e8

show abstract

Section: Discussionmentioning

confidence: 99%

Antihypertensive Prescribing Patterns for Adolescents With Primary Hypertension

Yoon¹,

Cohn²,

Rocchini³

et al. 2012

Pediatrics

View full text Add to dashboard Cite

show abstract

“…[5][6][7][8][9] In addition, several other important findings were observed. First, the distributions of response values for SBP and DBP change were much greater within each race group than between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] More specifically, blacks with hypertension have been reported to be less responsive to monotherapy with angiotensin-converting enzyme (ACE) inhibitors, 5 ␤-blockers, 6 -8 and angiotensin receptor blockers 9 than to diuretics and calcium antagonists. Many of these same studies have reported that white hypertensive patients respond better to these antihypertensive agents than do blacks.…”

mentioning

confidence: 99%

Determinants of Blood Pressure Response to Quinapril in Black and White Hypertensive Patients

et al. 2004

Self Cite

View full text Add to dashboard Cite

Abstract-Race has been considered an important factor in determining blood pressure response to treatment and selection of antihypertensive drug therapy. Data collected during a clinical trial that evaluated rapidity of medication up-titration with blood pressure response to monotherapy with the angiotensin-converting enzyme (ACE) inhibitor quinapril were used to characterize response in 533 black and 2046 white participants. Our objectives were to examine the influence of race and other factors on blood pressure response and to assess the degree to which nonrace factors account for apparent racial differences in response. Average systolic and diastolic blood pressure responses (baseline minus follow-up) to treatment were assessed with treatment groups combined. Crude systolic and diastolic blood pressure responses averaged 4.7 and 2.4 mm Hg less, respectively, in black compared with white participants; however, the response distributions largely overlapped. In multivariate linear regression models adjusted for study design variables and measured participant characteristics, the racial difference in systolic response was reduced by 51% to 2.3 mm Hg, and diastolic response by 21% to 1.9 mm Hg. In these models, participant characteristics, including age, gender, body size, and pretreatment blood pressure severity, significantly predicted either attenuated or enhanced blood pressure response to treatment. Our findings demonstrate that a large source of variability of blood pressure response to treatment is within, not between, racial groups, and that factors that vary at the level of the individual contribute to apparent racial differences in response to treatment. Key Words: ACE inhibitors Ⅲ antihypertensive therapy Ⅲ blood pressure response Ⅲ hypertension Ⅲ race R ace has long been considered an important factor in determining blood pressure (BP) response to treatment, at least to single antihypertensive drugs. [1][2][3][4] More specifically, blacks with hypertension have been reported to be less responsive to monotherapy with angiotensin-converting enzyme (ACE) inhibitors, 5 ␤-blockers, 6 -8 and angiotensin receptor blockers 9 than to diuretics and calcium antagonists. Many of these same studies have reported that white hypertensive patients respond better to these antihypertensive agents than do blacks. 10,11,1,3,4 Authoritative treatment guidelines such as the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 12 have acknowledged this evidence of lesser BP response among blacks to certain drug classes and have not dismissed the notion that race be considered when selecting antihypertensive drug therapy.There are concerns, however, with the interpretation of data from these studies. First, black and white hypertensives typically differ on baseline characteristics 13,14 that may confound racial differences in BP response; observed response differences have almost never been adjusted for potential confounding factors other than baseline BP. Second, when racial BP ...

show abstract

“…Strong evidence of target-organ protection in African American patients (AASK) Some evidence of less blood pressure−lowering efficacy as monotherapy in African American vs white patients Some evidence of more cough and angioedema related to ACE inhibitor therapy in African American patients compared with white patients ARBs [20][21][22][23]86,94,95 Newest class of agents, so fewer data on clinical outcomes…”

Section: Target-organ Protectionmentioning

confidence: 99%

Management of High Blood Pressure in African Americans<subtitle>Consensus Statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks</subtitle>

et al. 2003

View full text Add to dashboard Cite

T he purpose of this consensus statement is to offer primary care providers (including physicians, nurse practitioners, and physician assistants) a practical, evidence-based clinical tool for achieving blood pressure goals in African American patients. The need for specific recommendations for African Americans is highlighted by compelling evidence of a higher prevalence of hypertension and poorer cardiovascular and renal outcomes in this group than in white Americans. African Americans have disturbingly higher rates of cardiovascular mortality, stroke, hypertension-related heart disease, congestive heart failure, type 2 diabetes mellitus, hypertensive nephropathy, and end-stage renal disease (ESRD).

show abstract

Antihypertensive efficacy and safety of losartan alone and in combination with hydrochlorothiazide in adult African Americans with mild to moderate hypertension

Cited by 59 publications

References 37 publications

Antihypertensive Prescribing Patterns for Adolescents With Primary Hypertension

Antihypertensive Prescribing Patterns for Adolescents With Primary Hypertension

Determinants of Blood Pressure Response to Quinapril in Black and White Hypertensive Patients

Management of High Blood Pressure in African Americans<subtitle>Consensus Statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks</subtitle>

Contact Info

Product

Resources

About