Document Detail


Ethnic differences in blood pressure response to first and second-line antihypertensive therapies in patients randomized in the ASCOT Trial.
MedLine Citation:
PMID:  20725056     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Some studies suggest that blood pressure (BP)-lowering effects of commonly used antihypertensive drugs differ among ethnic groups. However, differences in the response to second-line therapy have not been studied extensively.
METHODS: In the BP-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA), BP levels of European (n = 4,368), African (203), and South-Asian- (132) origin patients on unchanged monotherapy (atenolol or amlodipine) and/or on second-line therapy (added thiazide or perindopril) were compared. Interaction between ethnicity and BP responses (defined as end BP minus start of therapy BP) to both first- and second-line therapies were assessed in regression models after accounting for age, sex, and several other potential confounders.
RESULTS: BP response to atenolol and amlodipine monotherapy differed among the three ethnic groups (interaction test P = 0.05). Among those allocated atenolol monotherapy, black patients were significantly less responsive (mean systolic BP (SBP) difference +1.7 (95% confidence interval: -1.1 to 4.6) mm Hg) compared to white patients (referent). In contrast, BP response to amlodipine monotherapy did not differ significantly by ethnic group. BP responses to the addition of second-line therapy also differed significantly by ethnic group (interaction test P = 0.004). On adding a diuretic to atenolol, BP lowering was similar among blacks and South-Asians as compared to whites (referent). However, on addition of perindopril to amlodipine, BP responses differed significantly: compared to whites (SBP difference -1.7 (-2.8 to -0.7) mm Hg), black patients had a lesser response (SBP difference 0.8 (-2.5 to 4.2) mm Hg) and South-Asians had a greater response (SBP difference -6.2 (-10.2 to -2.2) mm Hg).
CONCLUSIONS: We found important differences in BP responses among ethnic groups to both first- and second-line antihypertensive therapies.
Authors:
Ajay K Gupta; Neil R Poulter; Joanna Dobson; Sandra Eldridge; Francesco P Cappuccio; Mark Caulfield; David Collier; J Kennedy Cruickshank; Peter S Sever; Gene Feder;
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-08-19
Journal Detail:
Title:  American journal of hypertension     Volume:  23     ISSN:  1941-7225     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-24     Completed Date:  2010-12-07     Revised Date:  2011-06-30    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1023-30     Citation Subset:  IM    
Affiliation:
ICCH, Imperial College London, London, UK. A.K.Gupta@imperial.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Amlodipine / therapeutic use*
Antihypertensive Agents / therapeutic use*
Atenolol / therapeutic use*
Blood Pressure / drug effects*
Confounding Factors (Epidemiology)
Continental Population Groups / statistics & numerical data
Diuretics / therapeutic use*
Drug Therapy, Combination
Female
Humans
Hypertension / drug therapy*,  ethnology*
Male
Middle Aged
Multicenter Studies as Topic
Perindopril / therapeutic use*
Randomized Controlled Trials as Topic
Sex Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Diuretics; 29122-68-7/Atenolol; 82834-16-0/Perindopril; 88150-42-9/Amlodipine
Comments/Corrections
Comment In:
Am J Hypertens. 2010 Sep;23(9):926-8   [PMID:  20733564 ]
Curr Hypertens Rep. 2011 Feb;13(1):8-10   [PMID:  21080239 ]
Am J Hypertens. 2010 Sep;23(9):929-30   [PMID:  20733565 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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