Key result
African women on combination antihypertensives are ~59% more likely to achieve BP targets than men.
Why the study?
Data were lacking to support evidence-based hypertension management and optimal blood pressure control on a sex-specific basis in Africa.
Are there sex-specific differences in the response to different antihypertensive combination therapies among Black Africans?
RCT (n=635)
randomly allocated
Yes
Are there sex-specific differences in the response to different antihypertensive combination therapies among Black Africans?
Odds Ratio: 1.59 (95% CI 1.07–2.39)
Absolute Event Rate: 72% vs 65.5%
p-value: p=0.023
African women with hypertension demonstrate a better therapeutic response to amlodipine-based combination therapies compared to African men.
May support sex-specific antihypertensive selection in Black Africans; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: We sought to address the paucity of data to support the evidence-based management of hypertension to achieve optimal blood pressure (BP) control on a sex-specific basis in Africa. METHODS: We undertook a post hoc analysis of the multicenter, randomized CREOLE (Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans) Trial to test the hypothesis that there would be clinically important differences in office BP control between African men and women. We compared the BP levels of 397 and 238 hypertensive women (63%, 50.9 ± 10.5 years) and men (51.2 ± 11.3 years) from 10 sites across sub-Saharan Africa who completed baseline and 6-month profiling according to their randomly allocated antihypertensive treatment. RESULTS: Overall, 442/635 (69.6%) participants achieved an office BP target of <140/90 mm Hg at 6 months; comprising more women (286/72.0%) than men (156/65.5%) (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.07-2.39; P = 0.023). Women randomized to amlodipine-hydrochlorothiazide (HCTZ) (adjusted OR 3.03, 95% CI 1.71-5.35; P < 0.001) or amlodipine-perindopril (adjusted OR 2.62, 95% CI 1.49-4.58; P = 0.01) were more likely to achieve this target compared with perindopril-HCTZ. Among men, there were no equivalent treatment differences-amlodipine-HCTZ (OR 1.54, 95% CI 0.76-3.12; P = 0.23) or amlodipine-perindopril (OR 1.32, 95% CI 0.65-2.67; P = 0.44) vs. perindopril-HCTZ. Among the 613 participants (97%) with 24-hour ambulatory BP monitoring, women had significantly lower systolic (124.1 ± 18.1 vs. 127.3 ± 16.9; P = 0.028) and diastolic (72.7 ± 10.4 vs. 75.1 ± 10.5; P = 0.007) BP levels at 6 months compared with men. CONCLUSIONS: These data suggest clinically important differences in the therapeutic response to antihypertensive combination therapy among African women compared with African men.
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Ojji et al. (2022) conducted an RCT in Hypertension (n=635). Female sex vs. Male sex was evaluated on Office blood pressure target of <140/90 mm Hg at 6 months (adjusted OR 1.59, 95% CI 1.07-2.39, p=0.023). African women on antihypertensive combination therapy were more likely to achieve a blood pressure target of <140/90 mm Hg at 6 months than men (72.0% vs 65.5%; OR 1.59, 95% CI 1.07-2.39; P=0.023).
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