Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks

Bangalore, Sripal; Ogedegbe, Gbenga; Gyamfi, Joyce; Guo, Yu; Roy, Jason; Goldfeld, Keith; Torgersen, Christopher; Capponi, Louis; Phillips, Charles R.; Shah, Nirav R.

doi:10.1016/j.amjmed.2015.04.034

Cited by 22 publications

(22 citation statements)

References 38 publications

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“…It included a cohort of 25,564 propensity score-matched hypertensive AA patients. ACEIs were associated with a higher risk of primary outcome (myocardial infarction, stroke, and heart failure) compared with CCB (4,506 matched pairs; HR 1.45, 95% CI 1.19–1.77; P = 0.0003), and a higher risk for primary outcome was observed when ACEIs were compared with thiazide diuretics in AAs (5,337 matched pairs; HR 1.65, 95% CI 1.33–2.05; P < 0.0001) 90 . A meta-analysis of 13 different trials in the USA and Europe showed that SBP and diastolic BP reduction with ACEI monotherapy was consistently lower among AAs than among whites 91 .…”

Section: Predictors Of Renin-angiotensin-aldosterone System Blockade mentioning

confidence: 99%

Advances in understanding the renin-angiotensin-aldosterone system (RAAS) in blood pressure control and recent pivotal trials of RAAS blockade in heart failure and diabetic nephropathy

Ghazi

Drawz

2017

F1000Res

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The renin-angiotensin-aldosterone system (RAAS) plays a fundamental role in the physiology of blood pressure control and the pathophysiology of hypertension (HTN) with effects on vascular tone, sodium retention, oxidative stress, fibrosis, sympathetic tone, and inflammation. Fortunately, RAAS blocking agents have been available to treat HTN since the 1970s and newer medications are being developed. In this review, we will (1) examine new anti-hypertensive medications affecting the RAAS, (2) evaluate recent studies that help provide a better understanding of which patients may be more likely to benefit from RAAS blockade, and (3) review three recent pivotal randomized trials that involve newer RAAS blocking agents and inform clinical practice.

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Section: Predictors Of Renin-angiotensin-aldosterone System Blockade mentioning

confidence: 99%

Advances in understanding the renin-angiotensin-aldosterone system (RAAS) in blood pressure control and recent pivotal trials of RAAS blockade in heart failure and diabetic nephropathy

Ghazi

Drawz

2017

F1000Res

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“…8 ACE inhibitors were compared with CCBs in the African American Study of Kidney Disease and Hypertension (AASK) trial, 11 the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial, 10 and Bangalore and colleagues 8 ; diuretics in the ALLHAT trial 10 and Bangalore and colleagues 8 ; and b-blockers in the AASK trial, 11 Bangalore and colleagues, and the Losartan Intervention For Endpoint Reduction (LIFE) study. 9 All included studies were deemed to be at low risk of bias.…”

Section: Study Selectionmentioning

confidence: 99%

“…[8][9][10][11] Of the four studies, three were subgroup analyses of randomized control trials [9][10][11] and one was a propensitymatched cohort analysis.…”

Section: Study Selectionmentioning

confidence: 99%

“…8 We sought to review and analyze CV outcomes in hypertensive blacks treated with different antihypertensive classes.…”

mentioning

confidence: 99%

“…7 A recent analysis of New York City Health and Hospital Corporation's clinical data showed significantly higher all-cause mortality and myocardial infarction (MI) rates in hypertensive blacks treated with ACE inhibitors. 8 We sought to review and analyze CV outcomes in hypertensive blacks treated with different antihypertensive classes.…”

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confidence: 99%

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Renin‐Angiotensin System Inhibitors vs Other Antihypertensives in Hypertensive Blacks: A Meta‐Analysis

Palla

Ando

Androulakis

et al. 2016

J of Clinical Hypertension

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The purpose of this study was to assess the effects of reninangiotensin system (RAS) inhibitors vs other antihypertensive agents on cardiovascular outcomes in hypertensive black patients. The authors performed a systematic review and meta-analysis of studies that compared the effects of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) with calcium channel blockers (CCBs), diuretics, and b-blockers in hypertensive black patients on cardiovascular outcomes. A total of 38,983 patients with a mean age of 60 years and mean follow-up of 4 years were included in our meta-analysis. No significant differences were found in all-cause mortality, myocardial infarction, heart failure, and cardiovascular mortality rates among patients treated with RAS inhibitors compared with CCBs, diuretics, and b-blockers. The incidence of stroke was significantly increased in patients treated with RAS inhibitors compared with CCBs (odds ratio, 1.56; 95% confidence interval, 1. Hypertension (HTN) in African Americans is often more severe and resistant to antihypertensive therapy and leads to earlier target organ damage and higher cardiovascular (CV) events compared with whites. [1][2][3] Response to antihypertensive drug classes may be different among different age and race subgroups. Black and elderly patients exhibit better blood pressure (BP) response to thiazide diuretics or long-acting calcium channel blockers (CCBs), provided they don't have a specific indication for angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) such as heart failure (HF) or proteinuric chronic kidney disease. 4 In contrast, younger white patients respond better to ACE inhibitors or ARBs.4-6 The observed differences may be the result of lower plasma renin activity in hypertensive blacks.7 A recent analysis of New York City Health and Hospital Corporation's clinical data showed significantly higher all-cause mortality and myocardial infarction (MI) rates in hypertensive blacks treated with ACE inhibitors. 8 We sought to review and analyze CV outcomes in hypertensive blacks treated with different antihypertensive classes. METHODS Search StrategySystematic electronic search was performed on MED-LINE (PubMed interface), Embase, and Cochrane Central Registry of Controlled Trials (CENTRAL) with no language limitations. Using the MESH terms, we searched the following key terms: hypertension, blacks, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, and b-blockers. Two reviewers (M.P. and A.B.) independently screened titles and abstracts based on inclusion and exclusion criteria. After eliminating irrelevant studies, full-text reports were reviewed. Review articles were excluded. Subsequently, we performed a hand search of all included randomized clinical trials and observational studies until no further relevant studies were identified. Finally, a total of four studies were identified. Study SelectionWe included randomized clinical trials...

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Important Differences in Cardiovascular Care

Hall

2019

Patient-Centered Clinical Care for African Americans

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Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks

Abstract: In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics.

Cited by 22 publications

References 38 publications

Advances in understanding the renin-angiotensin-aldosterone system (RAAS) in blood pressure control and recent pivotal trials of RAAS blockade in heart failure and diabetic nephropathy

Advances in understanding the renin-angiotensin-aldosterone system (RAAS) in blood pressure control and recent pivotal trials of RAAS blockade in heart failure and diabetic nephropathy

Renin‐Angiotensin System Inhibitors vs Other Antihypertensives in Hypertensive Blacks: A Meta‐Analysis

Important Differences in Cardiovascular Care

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