Key result
In hypertensive black patients, RAS inhibitors significantly increased the incidence of stroke compared with calcium channel blockers (OR 1.56) and diuretics (OR 1.59).
Why the study?
Do renin-angiotensin system inhibitors improve cardiovascular outcomes compared to other antihypertensives in hypertensive black patients?
Meta-Analysis (n=38,983)
Do renin-angiotensin system inhibitors improve cardiovascular outcomes compared to other antihypertensives in hypertensive black patients?
Odds Ratio: 1.56 (95% CI 1.31–1.87)
p-value: p=<.00001
In hypertensive black patients, RAS inhibitors are associated with a higher risk of stroke compared to CCBs and diuretics, likely due to lesser blood pressure reduction, while other cardiovascular outcomes are similar.
RAS inhibitors may increase stroke risk in black hypertensives; reinforces first-line CCBs or diuretics per guidelines.
The purpose of this study was to assess the effects of renin‐angiotensin 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 β‐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 β‐blockers. The incidence of stroke was significantly increased in patients treated with RAS inhibitors compared with CCBs (odds ratio, 1.56; 95% confidence interval, 1.31–1.87 [P<.00001]; I2=0%) and diuretics (odds ratio, 1.59; 95% confidence interval, 1.16–2.17 [P=.004]; I2=56%) but not β‐blockers.
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Palla et al. (2016) conducted a meta-analysis in Hypertension (n=38,983). Renin-angiotensin system (RAS) inhibitors vs. Calcium channel blockers, diuretics, and beta-blockers was evaluated on Stroke (RAS inhibitors vs CCBs) (OR 1.56, 95% CI 1.31-1.87, p=<.00001). In hypertensive black patients, RAS inhibitors significantly increased the incidence of stroke compared with calcium channel blockers (OR 1.56) and diuretics (OR 1.59).
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