March 30, 2016Internal and Emergency MedicineOpen Access

Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Uncomplicated primary hypertension (n=27259). Intervention: Antihypertensive drug therapy vs. Placebo or other antihypertensive drugs. Primary outcome: Stroke (lisinopril vs chlorthalidone in African ethnicity) (RR 1.40, 95% CI 1.17-1.68).

Q: What does this research mean for the field?

In patients of African ethnicity, initiating treatment with ACE inhibitors or angiotensin II receptor blockers is associated with adverse cardiovascular outcomes, whereas no significant differences in efficacy exist between antihypertensive drugs in South Asian patients. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

In patients of African ethnicity, treatment initiated with ACE inhibitors or angiotensin II receptor blockers was associated with adverse cardiovascular outcomes, whereas no significant differences in efficacy were found between antihypertensive drugs in South Asians.

Why the study?

Does antihypertensive drug therapy effectively reduce blood pressure and cardiovascular morbidity/mortality in hypertensive patients of African and South Asian ethnicity?

Population

27,259 adults with uncomplicated primary hypertension, comprising 25,540 patients of African ethnicity and…

Comparison

Antihypertensive monotherapy or combination… vs Concurrent placebo treatment or active comparator.

Design

Meta-analysis, Randomized controlled trials, Varied

Follow-up

2 weeks to 5 years

Authors

LBLizzy M. BrewsterPreventive Cardiology GMGert A. van MontfransCincinnati Children's Hospital Medical Center GOG.P. OehlersAcademic Hospital Paramaribo

Discussion

Member takes

Implication

May warrant avoiding ACE inhibitors or ARBs as initial therapy in African ethnicity patients; extends ethnicity-specific evidence to South Asians.

Study Design

Type

Systematic Review (n=27,259)

Structured PICO

Does antihypertensive drug therapy effectively reduce blood pressure and cardiovascular morbidity/mortality in hypertensive patients of African and South Asian ethnicity?

Population

27,259 adults with uncomplicated primary hypertension (no history of or current cardiovascular events or ESRD), comprising 25,540 patients of African ethnicity (from 35 trials) and 1,719 patients of South Asian ethnicity (from 16 trials).

Intervention

Antihypertensive monotherapy or combination therapy from 7 major drug classes (thiazide and thiazide-like diuretics, calcium-channel blockers, centrally acting agents, peripheral adrenergic neuron antagonists, ACE inhibitors, angiotensin II receptor blockers, beta-blockers).

Comparator

Concurrent placebo treatment or active comparator (other antihypertensive drugs).

Outcome

Blood pressure reduction (systolic and diastolic) and morbidity or mortality outcomes (stroke, sudden death, cardiovascular events).surrogate

Main Result

Effect estimate: RR 1.40 (95% CI 1.17-1.68)

In patients of African ethnicity, calcium channel blockers and diuretics are more effective for blood pressure control, whereas ACE inhibitors and ARBs are associated with worse cardiovascular outcomes; evidence in South Asians is limited but shows no significant difference between drug classes for blood pressure lowering.

Limitations

Participation of ethnic minority groups in major clinical trials is generally too low to calculate primary outcomes with sufficient power
Methodological quality of trials in South Asian patients was low
Heterogeneity in trial data that could not be well accounted for
Lack of trials with mortality outcomes in South Asian patients
Small number of trials and lack of morbidity/mortality trials in South Asians
Low methodological quality of South Asian trials (Jadad scores 1-4)
Limited data on gender differences
Heterogeneity in trial data

Cite This Study

Brewster et al. (2016) conducted a systematic review in Uncomplicated primary hypertension (n=27,259). Antihypertensive drug therapy vs. Placebo or other antihypertensive drugs was evaluated on Stroke (lisinopril vs chlorthalidone in African ethnicity) (RR 1.40, 95% CI 1.17-1.68). In patients of African ethnicity, treatment initiated with ACE inhibitors or angiotensin II receptor blockers was associated with adverse cardiovascular outcomes, whereas no significant differences in efficacy were found between antihypertensive drugs in South Asians.

synapsesocial.com/papers/6a127c3dc031bb6829a6b3b4 https://doi.org/10.1007/s11739-016-1422-x

Topics

Hypertension management

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Implication

May warrant avoiding ACE inhibitors or ARBs as initial therapy in African ethnicity patients; extends ethnicity-specific evidence to South Asians.

Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider