Afro-American patients with hypertension had a higher risk of myocardial infarction (OR 1.003; 95% CI 1.001-1.005; p=0.011), heart failure, stroke, and CV death compared to Caucasians.
Meta-Analysis (n=142,871)
Does ethnicity impact the incidence of major cardiovascular events in adult patients with hypertension receiving antihypertensive treatment?
Afro-American and Asian hypertensive patients exhibit distinct cardiovascular risk profiles compared to Caucasians, highlighting the need for ethnicity-tailored antihypertensive strategies.
Effect estimate: OR 1.003 (95% CI 1.001-1.005)
p-value: p=0.011
Abstract Background Hypertension is a major risk factor for cardiovascular (CV) mortality and morbidity. However, it remains unclear if significant ethnic differences exist in hypertension and hypertension-related outcomes, and their impact is still debated. Purpose We conducted a meta-regression analysis to compare the outcomes of major cardiovascular events (myocardial infarction, stroke, heart failure, cardiovascular death) across different ethnic groups in randomized controlled trials (RCTs) evaluating antihypertensive treatment. Methods RCTs published between 1997 and 2024 in peer-reviewed journals indexed in the PubMed and EMBASE databases were selected. Eligible studies included a homogeneous population of Afro-American, Caucasian, or Asian patients with hypertension. Results A total of 142,871 patients (82,472 Caucasian, 16,221 Afro-American and 44,178 Asian patients) from 24 RCTs were included in the meta-regression. After adjusting for basal systolic blood pressure, age, sex, 10 mmHg systolic pressure reduction, and high CV risk, CV outcomes were found to differ significantly across ethnicities. Compared to Caucasians, Afro-American patients had a significantly higher incidence of myocardial infarction (9.8 events per 1000 patient-years; OR 1.003; 95% CI 1.001-1.005; p=0.011), heart failure (9.6 events per 1000 patient-years; OR 1.006; 95% CI 1.003-1.008; p0.001), stroke (10.5 events per 1000 patient-years; OR 1.004; 95% CI 1.000-1.007; p=0.037) and cardiovascular death (9.8 events per 1000 patient-years; OR 1.006; 95% CI 1.003-1.010; p=0.001). Conversely, Asian patients were more prone to stroke (11.9 events per 1000 patient-years; OR 1.004; 95% CI 1.002-1.007; p=0.002) but had a lower risk of myocardial infarction (4.4 events per 1000 patient-years; OR 0.998; 95% CI 0.996-0.999; p=0.002) compared to Caucasian patients. Conclusion Ethnic disparities exist in CV outcomes among adult hypertensive patients. Afro-American patients present higher CV morbidity, while Asian patients are specifically at higher risk of stroke compared to Caucasian patients. These differences should be considered when selecting the most appropriate anti-hypertensive treatment.
Bernardi et al. (2025) conducted a meta-analysis in hypertension (n=142,871). Afro-American ethnicity vs. Caucasian ethnicity was evaluated on myocardial infarction (OR 1.003, 95% CI 1.001-1.005, p=0.011). Afro-American patients with hypertension had a higher risk of myocardial infarction (OR 1.003; 95% CI 1.001-1.005; p=0.011), heart failure, stroke, and CV death compared to Caucasians.