Racial Differences in Blood Pressure Response to Calcium Channel Blocker Monotherapy: A Meta-Analysis

BACKGROUND: A systematic literature review was conducted to determine whether US blacks and whites have differential blood pressure (BP) response to calcium channel blocker (CCB) monotherapy. METHODS: Six published studies made up the final cohort of eligible articles. Multiple treatment groups within some studies led to a total of eight sets of estimates for BP reduction with a total of 6,851 white or nonblack participants and 3,371 black participants. RESULTS: The pooled difference in systolic blood pressure (SBP) change between blacks and whites was -2.7 mm Hg (95% confidence interval (CI): -4.0, -1.3) with blacks having greater response. The difference in diastolic blood pressure (DBP) between blacks and whites was -0.4 mm Hg (95% CI: -1.0, 0.3) with blacks having greater response. Using a dichotomous outcome measure, whites were found to be just as likely as blacks to attain the DBP goal of <90 mm Hg or a 10 mm Hg or greater change (relative risk: 1.00 95% CI: 0.91, 1.11). In addition, examination of the continuous distribution of BP responses of whites and blacks showed over 90% overlap in treatment response. CONCLUSION: Assessment of differential response to CCB monotherapy by race in published data depends on choice of outcome metric. Nonetheless, the results of this systematic review indicate that BP response is qualitatively similar in US blacks and whites, suggesting that patient race is not likely to offer any clinical utility for decisions about the likely effect of this antihypertensive therapy.