Key result
In hypertensive African ancestry adults, hydrochlorothiazide plus benazepril yielded a combined morbidity/mortality rate of 8.9% compared to 6.6% for amlodipine plus benazepril (RR 1.35; 95% CI 0.94-1.94).
Why the study?
Does initial dual antihypertensive combination treatment improve blood pressure, morbidity, or mortality in hypertensive African ancestry adults?
Systematic Review (n=3,843)
Does initial dual antihypertensive combination treatment improve blood pressure, morbidity, or mortality in hypertensive African ancestry adults?
Relative Risk: 1.35 (95% CI 0.94–1.94)
Absolute Event Rate: 8.9% vs 6.6%
In hypertensive patients of African ancestry, limited evidence supports calcium channel blocker + ACEI over hydrochlorothiazide + ACEI as first-line initial combination therapy.
May favor amlodipine-benazepril over hydrochlorothiazide-benazepril; extends combination regimen selection data in African ancestry hypertension.
We systematically reviewed randomized controlled trials (RCTs) that consider the effect of initial dual antihypertensive combination treatment on blood pressure (BP), morbidity, or mortality in hypertensive African ancestry adults, using the methodology of the Cochrane Collaboration. Main outcomes were difference in means (continuous data) and risk ratio (dichotomous data).We retrieved 1728 reports yielding 13 RCTs of 4 weeks to 3 years duration (median 8 weeks) in 3843 patients. Systolic BP was significantly higher on β-adrenergic blocker vs. other combinations, 3.80 [0.82;6.78] mmHg, but comparable for other combinations. Hypokalemia and hyperglycemia occurred with calcium channel blocker (CCB) + diuretics > diuretics + angiotensin converting enzyme inhibitor (ACEI)/angiotensin-II-type-1-receptor antagonist (ARB) > CCB + ACEI/ARB. An RCT including high-risk patients reported combined morbidity/mortality for hydrochlorothiazide (mg) 25 + benazepril 40 vs. amlodipine 10 + benazepril 40 of respectively 8.9% vs. 6.6% (n = 1414, risk ratio 1.35 [0.94;1.94]; all patients, N = 11 506, 1.23 [1.11;1.37]).We conclude that limited evidence supports CCB + ACEI rather than HCT + ACEI as first-line initial combination therapy in African ancestry patients with hypertension. PROSPERO: CRD42021238529.
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A 2022 study conducted a systematic review in hypertension (n=3,843). hydrochlorothiazide + benazepril vs. amlodipine 10 mg + benazepril 40 mg was evaluated on combined morbidity/mortality (RR 1.35, 95% CI 0.94-1.94). In hypertensive African ancestry adults, hydrochlorothiazide plus benazepril yielded a combined morbidity/mortality rate of 8.9% compared to 6.6% for amlodipine plus benazepril (RR 1.35; 95% CI 0.94-1.94).
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